In this episode of "Healthcare on the Rocks: Employee Benefits with a Twist," Scott Vold, the Chief Commercial Officer at Renalogic, describes the complexities of kidney disease, its treatment, and the economic impact on employers and their health plans. Scott talks about the critical and often overlooked public health crisis of chronic kidney disease (CKD) and the intricacies of the dialysis market.
With a background in health technology and actuary, Scott explains Renalogic's mission to manage both the human and financial costs of CKD for self-funded health plans. He shares eye-opening statistics, such as the fact that about 37 million adult Americans have CKD, with a staggering 90% unaware of their condition, highlighting the disease's silent proliferation and its ranking as the ninth-leading cause of death in the U.S., projected to rise to fifth by 2040.
The discussion also covers the evolution of the dialysis market into a duopoly, which has led to inflated costs for treatments, emphasizing the need for a strategic approach to healthcare management within self-funded health plans.
Key takeaways from the episode include:
The episode provides an insightful perspective on the challenges of managing CKD and the strategies employers can adopt to address this growing concern, emphasizing the importance of proactive healthcare management and specialized care programs in improving patient outcomes and achieving cost savings.
Stay in Touch!
Connect with our co-hosts Jennifer Jones and David Pittman
Have feedback, questions, or suggestions for show ideas? Send them to us at podcast@springbuk.com.
Please rate and review us on your favorite podcast platform, and share it with your friends and colleagues. We appreciate you and thank you for listening!
Produced by David Pittman
Theme music: "Overboard" by Stay Outside
In this episode of "Healthcare on the Rocks: Employee Benefits with a Twist," Scott Vold, the Chief Commercial Officer at Renalogic, describes the complexities of kidney disease, its treatment, and the economic impact on employers and their health plans. Scott talks about the critical and often overlooked public health crisis of chronic kidney disease (CKD) and the intricacies of the dialysis market.
With a background in health technology and actuary, Scott explains Renalogic's mission to manage both the human and financial costs of CKD for self-funded health plans. He shares eye-opening statistics, such as the fact that about 37 million adult Americans have CKD, with a staggering 90% unaware of their condition, highlighting the disease's silent proliferation and its ranking as the ninth-leading cause of death in the U.S., projected to rise to fifth by 2040.
The discussion also covers the evolution of the dialysis market into a duopoly, which has led to inflated costs for treatments, emphasizing the need for a strategic approach to healthcare management within self-funded health plans.
Key takeaways from the episode include:
The episode provides an insightful perspective on the challenges of managing CKD and the strategies employers can adopt to address this growing concern, emphasizing the importance of proactive healthcare management and specialized care programs in improving patient outcomes and achieving cost savings.
Stay in Touch!
Connect with our co-hosts Jennifer Jones and David Pittman
Have feedback, questions, or suggestions for show ideas? Send them to us at podcast@springbuk.com.
Please rate and review us on your favorite podcast platform, and share it with your friends and colleagues. We appreciate you and thank you for listening!
Produced by David Pittman
Theme music: "Overboard" by Stay Outside
04-16-24 Renalogic - Scott Vold
The Silent Epidemic: Unveiling the Impact of Kidney Disease on Employee Health and Benefits with Renalogic
[00:00:00] Renalogic - Jen:
Hello and thanks for joining us for Healthcare on the Rocks employee benefits with a twist.
Today we're going to be talking about kidney disease, the dialysis market, and the rising costs of treating this often long and costly condition. If you're an employer listening to this, you know the cost of dialysis or even transplants are likely in your top In our Employee Health Trends report this year, we saw chronic renal failure as a top 10 condition for two of the four high-cost claimant thresholds, and it's often one of those conditions where employees struggle to find a valuable solution that can impact cost and outcomes.
[00:00:34] Renalogic - David: Our guest today is Scott Vold, who has been the chief commercial officer at Renalogic since 2021. Prior to that, he was founder and CEO of Fibroblast, which redefined the physician referral management process and was eventually acquired by Cerner. Scott, welcome to the show.
[00:00:52] Renalogic - Scott: Jen, David, thank you very much. It's a pleasure to be on the show and look forward to chatting with you over the next, little time together and really I'm delighted about our partnership.
[00:01:04] Renalogic - David: Yeah, we're excited about it too and look forward to hearing more about that as well as you. So let's start off by having you just tell us a little bit more about your background and maybe even what Renalogic does.
[00:01:16] Renalogic - Scott: Sure. So as you mentioned before, I joined Renalogic in mid 2021, having led a health technology company Focused on large integrated delivery networks that was ultimately acquired by Cerner, which is now Oracle. And then I came in to help, lead the commercial function at RenoLogic in a, transition, of ownership of the company.
Renalogic is a 20-plus-year-old company, that is really committed to helping self-funded health plans manage the human and financial costs of chronic kidney disease. we really do that in kind of two ways. The first way is, and I'm sure we're going to expand upon these and talk about these kind of in detail.
But the first way is by helping self-funded plans reduce the unit cost of dialysis, which is wildly expensive in this country and kind of out of proportion to what's rational. The second thing we do is help self-funded health plans. identify and manage, chronic kidney disease risk in their health plan populations through an analytics offering, through some care management and through, care advocacy. And that's really the human component. It's helping health plan members lead, healthier, more productive, lives, and then also helping bend the cost trend, for the health plan, to, saving total cost of care.
[00:02:42] Renalogic - Jen: I think those two points are really important as you emphasize as far as what you both or what you focus on as far as reducing that unit cost. But then the second component as far as helping them manage and identify those with chronic kidney disease before they get to dialysis. That's always a huge part as far as within Springbuk, what we're trying to do as far as help our clients identify those with future risk, which, you know, as we all know, if you can treat something before it becomes this explosion, it can obviously help with overall costs in the long run too.
But as I opened this up, I mentioned, you know, chronic kidney disease and dialysis in particular is a significant condition that can be extremely costly and as you, as you mentioned, is really out of control when we think about the unit cost for dialysis. But let's start with really setting the stage and what can you tell us about the prevalence of chronic kidney disease as a whole?
[00:03:37] Renalogic - Scott: so chronic kidney disease I think is the public health crisis that far too few people are talking about. Um, about one in seven adult Americans or 37 million people have chronic kidney disease in this country. And that's wild in and of itself. What's I think even more wild and scary is that 90 percent of those people.
People have no idea they have chronic kidney disease. They're undiagnosed, they're walking around with this disease that's progressing without any indication to actually have it. It's currently the ninth-leading cause of death in the United States, and by 2040 it's projected to rise to the fifth-leading cause of death.
[00:04:25] Renalogic - David: Those are some astounding stats. So we've got 90 plus percent of people walking around and don't even know they have this deadly disease. So how, how does the dialysis market work? How does it work to help identify and, and treat these people?
[00:04:41] Renalogic - Scott: So CKD, chronic kidney disease, is caused by many of the same chronic conditions that are affecting more than 50 percent of Americans. So what we're really talking about is diabetes, high blood pressure, heart disease, and obesity. And as the rates of those conditions continue to rise among Americans or adult Americans, we see and we will continue to see the prevalence of CKD rise as well.
And so, I think ultimately, too, those, those things create a really vicious cycle that reinforce one another. Alright, so like, what's going on? What is CKD? And so in order to understand what CKD is, let's just quickly talk about what the kidneys do, um, because I think a lot of times people, don't have a great understanding of, of real kidney function, the job the kidneys play in the body.
So your kidneys have two jobs, right?
the first job, the kidneys have is to maintain the proper balance between water and electrolytes in your blood. Right? And this balance between water and electrolytes, sodium, potassium, some other minerals, is extremely important. And when it gets thrown off, it throws off a whole host of other really important bodily functions, including cardiovascular function.
And when the kidneys are damaged, when this balance is off, it can't regulate the balance, you see things like people having heart attacks or you see fluid building up in someone, around someone's lungs and over time and with too much fluid buildup or too many electrolytes in someone's bloodstream, you have really horrible things that can be fatal.
The other part of the kidney's job, their second job, I think most people understand, is to clean your blood. So, in the kidney you have these microscopic, functional units, they're called nephrons. And these are like filters in your blood and at the end of these nephrons there are these really delicate blood vessels called the glomeruli, which is really hard for me to say and I hate spelling.
[00:06:51] Renalogic - Jen: You did well. It's off
your
[00:06:54] Renalogic - Scott: Are these really delicate blood vessels and together, those are what actually kind of filter out toxins from your blood, right? And when someone has, um, diabetes, hypertension, you know, heart disease, obesity, those things tend to increase the pressure on these really delicate glomeruli and they break apart, they die, they get damaged.
And once the nephrons and glomeruli are damaged, they don't repair, they don't heal themselves, there's no surgery or medicine you can take to repair them. Once they're damaged, they're damaged. And so, you have, with kidney damage, you also have this, like, again, your blood isn't really filtering out these toxins.
Now, I mentioned, you know, these chronic conditions that are affecting most Americans and how they kind of have a downstream or, or reinforcing effect of chronic kidney disease. I like to think of a garden hose as an analogy. When you have high blood pressure, think of it as a water pressure going through this hose.
So high, blood pressure going through your, your, your blood vessels. And they go through the nephrons, they go through the glomeruli, and they break them apart, right? They, they damage them. And so that damages kidneys. When you have diabetes, and you have, you know, high amounts of circulating blood sugar, it's like having, shards of glass going through a garden hose, which obviously damage the hose, and in this case would damage the nephrons and glomeruli.
When you put all that together, high pressure shards of glass flowing through a garden hose, Much like high pressure in your blood with circulating sugar, it damages the kidneys and it creates this really horrific effect that ultimately leads to a worsening of the condition. So, if you you can get your arms around, all these other chronic conditions, you can also understand and really impact chronic kidney disease at a population level.
[00:08:50] Renalogic - Jen: I think that's a really helpful synopsis for most of our people like you said, that don't really understand the whole basis of what the kidneys are doing and those two different factors. One other thing that you mentioned, I think that's important to talk about too, is with hypertension, with diabetes, with obesity, obviously there are all biometric measures or tests that can be done to really diagnose someone with those types of conditions.
But with CKD, it's a little bit different because a lot of the blood tests we have are designed more to think about it from, how hydrated someone may be or, like, yeah, you can look at creatinine and BUN, but they're not always, like, the right test to measure as far as where they're truly, in chronic kidney disease.
GFR maybe, but I guess when you think about 90 percent of the people that have it, don't know they have it. Do you see where that is because it's not commonly tested or not tested the right way? And then do we see where there are certain subsets of the population where this tends to be at a higher undiagnosed rate than another?
[00:09:52] Renalogic - Scott: So with respect to kind of early detection or diagnosis and awareness of the disease, what is, um, so problematic about CKD is that, uh, it is a slow-developing disease and so someone can, that doesn't have many symptoms until the later stages.
So, so what we commonly see are people who have, you know, less than 70 percent of their kidney function. They're walking around with 20, 30 percent of kidney function left, and that's when they start to become symptomatic, right? So the standard of care today, is to diagnose chronic kidney disease when someone has 60 percent or less of their kidney function.
Now, why is that problematic? It's problematic because, CKD is organized into five stages,
In stage 1 and stage 2, and mostly in stage 3, people oftentimes have no symptoms whatsoever. You know, they, they, they go about their day, they think they're living a completely normal life. Um, they don't feel pain, they don't see anything in their urine, they have normal urine function.
And a lot of those people, as we've just discussed, are dealing with chronic conditions like obesity, hypertension, diabetes, there's other things going on. And it isn't until they reach a later stage, stage 3, stage 4, stage 5, that they start to exhibit symptoms. And in fact, we routinely see people, who aren't diagnosed and don't complain of symptoms of chronic kidney disease until they're way late stage, less than, you know, only 30 percent of their kidney function left. Today, the standard of care is to order what's called an EGFR test to diagnose chronic kidney disease. GFR stands for glomerular filtration rate, right?
So how fast, how, how efficiently, your kidneys, their glomeruli are filtering out your blood. The E is for estimated, so your estimated glomerular filtration rate. If you're a PCP, primary care doctor, and you order this test today, um, kind of your standard run of the mill test, what it's going to say is someone is in normal range, which means they have, 60 percent or more of their kidney function, or out of normal range, 60 percent or less.
And the problem with this is when you diagnose someone, with 60 percent or less of their kidney function, they're actually in stage three, right? That means that for decades their kidneys have been more and more damaged, their health of the kidneys have been deteriorating to the point at which they're sort of in the middle of chronic kidney disease and it's only then that they're diagnosed.
I think a better way to handle this is either for a primary care doctor to order a very inexpensive GFR test, EGFR test that has more sensitivity, and it could actually, um, indicate someone's EGFR rating, their, their kidney function at an earlier stage. And or to use data and analytics like one might find in Springbuk and Renalogic to look at other markers of health, other indicia of disease, um, and to, predict and estimate whether someone actually has chronic kidney disease.
[00:13:18] Renalogic - Jen: I think we've effectively scared everyone into thinking they probably are walking around with CKD.
[00:13:23] Renalogic - Scott: Yeah. Well, I mean, the sad thing is a lot of people are, right? And that the intention is to scare anyone, it's not a scare tactic. It's really to bring awareness. Um, and again, I want to answer the second part of your question, which are what communities or demographics or populations are more at risk, for kidney disease than others?
So there's a kind of a nuanced answer or a layered answer to that, which is the following. You know, first of all, older people are more at risk for kidney disease or have a higher prevalence rate than younger people. This is a disease, again, that accumulates or compounds over decades. And so, and kidney function just lessens over time, and so if you are over the age of 65 there's a high chance that you have some form of kidney impairment versus under 65.
Secondly, um, there are, as we mentioned before, you know, chronic, conditions that impact or cause kidney disease: diabetes, hypertension, obesity, cardiovascular disease. There are lifestyle choices that people have made that, um, are correlated with or causally related to chronic kidney disease, like alcohol abuse, drug abuse, or smoking histories.
Those people with autoimmune issues, in particular lupus, are at a higher risk of, of chronic kidney disease. I'll say that, um, there are, there are other factors that are more, um, socially determinant driven or socioeconomically driven that are also, um, you know, indicative of or, or related to chronic kidney disease.
So, people of color, African Americans, Hispanic Americans, Native Americans and Asian Americans, all are at increased risks of chronic kidney disease and the prevalence rate is two to four times higher, than, than non people of color when it comes to chronic kidney disease. Those that are, in, certain industries also evidence a higher rate of chronic kidney disease than others.
So, the building trades, manufacturing, trucking, hospitality, ironically and sadly, those in healthcare all have higher, prevalence rates of CKD than other industries. And then lastly, if you were to map you know, kind of rates of, obesity in the United States, what oftentimes you see is, you know, concentration of obesity in the Southeast and the Midwest.
I'm in Chicago, I'm in one of those states, and Illinois, you see kind of a high rate of obesity. I think that tracks with CKD. So lots of CKD in the South and Southeast and the Midwest, much less in the mountain states, right? Some in the Northeast. Yeah. And a lot in the Northwest and Pacific Northwest.
[00:16:09] Renalogic - Jen: Very helpful, thank you.
[00:16:12] Renalogic - David: What, is it just me or does everyone else suddenly feel like you have a little shards of glass just coursing through your veins?
veins
[00:16:20] Renalogic - Jen: I know, I noticed you took a drink of water, DP.
[00:16:23] Renalogic - David: Yeah, I know. I'm like, I've got a glass over here. I just want to chug the whole thing. No, that, that was amazing, Scott. So thank you for all that background. I never, I never understood all of that. And, Jen, I, I do want you to, before we're done with this episode, I want you to say what GFR stands for.
I want you
[00:16:43] Renalogic - Jen: I just have to say it really slow. Like, I've always referred to it as GFR.
[00:16:50] Renalogic - David: Well, that's cheating, so we're not going to let you get away with that. Anyway, Scott, we're joking. I shouldn't make light of it. This is obviously a very important and debilitating disease for so many people. Very important to employers as well as their employees and family members.
Alright, so Scott, help us understand now, what is the shape and the size of the dialysis market and then maybe bridge from there into what can employers do?
[00:17:23] Renalogic - Scott: So, the dialysis market in the United States is pretty wild. A couple, facts here to set some context up, so, um, yeah, I said 37 million American adults. with chronic kidney disease. At any given time, there are about 800,000 adults who have what's called end stage renal disease. This is kind of the commonly thought of as kidney failure.
You have less than 15 percent kidney function and the only way for you to continue to live quite literally is, on dialysis, which is a, you know, an artificial way to clean your blood. It's a machine that cleans your blood for you, or a kidney transplant. So, 800,000 people, with end stage renal disease diagnoses, and, you know, most, 99%, let's say, are on dialysis.
There's a small, segment that have had transplants or are awaiting transplant. Of that, 800,000 people, 80 to 85,000 are on commercial plans, and then the rest are on Medicare, right? So keep those facts in mind.
So this is a wild industry, for really quite literally life-saving treatment. Going back to kind of the forties and fifties and sixties, there was a lot of innovation in the dialysis market. There were a lot of non for profit or academic medical centers who were coming up with ways to filter people's blood, because they recognized that, um, end stage renal disease was a just horrific condition and people were dying.
And so a lot of really well intentioned academic medical centers and non for profit organizations create all kinds of innovation in the industry. Problem was it was all like absurdly and unconsciously expensive. Like no individual could really afford this life-saving care. It was a huge burden on employers to pay for it, and people were just dying because they couldn't get, they couldn't afford the care, and there wasn't enough machines to go around.
And so, you know, credit the federal government in this case for recognizing how important dialysis was to a large segment of Americans. And in the 70s, they enacted what has become the Medicare Secondary Payer Act. And without diving too deep into it, I think the most important thing to understand is Medicare Secondary Payer Act basically says, if you have a diagnosis of end stage renal disease and ALS, Lou Gehrig's disease, which is a kind of a different thing, you qualify for Medicare regardless of any other, criteria. Meaning you don't have, you can be a 44-year-old person, not a 65-year-old person, and so long as you have end stage renal disease, you qualify. And Medicare will pay for your dialysis. Now, that really means is, Medicare will pay for your dialysis after this 33-month period.
There's three months where you kind of have to, you get diagnosed, you enroll in Medicare, you're eligible, there's a three-month waiting period, and then a 30-month period where the employer remains the primary payer, and then after that period of time, the government for the remainder of your life, or until you're transplanted, um, will pay for your dialysis.
Alright? So, throughout the 70s and 80s and 90s, this was a, an industry that had some not for profits, some for profits, medical centers, like some independent clinics where everyone's getting dialysis, and it was like reasonably competitive. And then kind of beginning in the 90s, two, you know, very large companies started rolling up, consolidating the market, and what we have today in the United States is a broken market.
We have a duopoly. Where two companies, DaVita, which is publicly traded and based in Colorado, and Fresenius, which is a German company with a U.S. subsidiary, also public, um, they control, combined, about 80-85 percent of the market. And they have a duopoly, they have price and power, all kinds of things that go around with them.
You know, no complicated duopoly in this country, and they are the major players for dialysis in this country. So much so that in a lot of the country, a person who needs dialysis might only have a choice between DaVita or Fresenius, and then, you know, in another part of the country, they might only have a choice, you might only have one option, um, just DaVita or just Fresenius.
Now, you know, what's the net of all this, right? The net of all this is that it's thrown the pricing for dialysis all out of whack. And where it used to be market driven, and people had choice, and health plans had bargaining power, and networks had bargaining power. That is not the case today. Today, health plans, especially self-funded health plans, are really burdened by excessive dialysis prices.
And as it flows down to health plan members, it's really difficult too because they have, you know, limited choice, gated access, to dialysis services.
[00:22:54] Renalogic - Jen: Two things I want to point out here, because I know we were talking about it earlier, and I'm going to bring my Exhibit A into screen here as far as the book, How to Make a Killing, which talks specifically about what Scott just outlined as far as the dialysis industry, how this was so innovative when dialysis first came to market.
And really since, I don't know, what would you say Scott, probably about the 80s, 90s, there's been very little innovation to how dialysis is performed today, whether it's hemo or um, Oh my gosh. Thank you. Thank you. And, and I don't even know, it may be helpful to just give a really high level as far as the difference and the patient experience.
Cause I don't know, you know, when you think about someone who goes into a dialysis center, that's three days a week that they need to go to those centers that they're there for hours to essentially clean and cleanse their blood of all the toxins that their kidneys can not clean anymore. Um, and just kind of what that experience
[00:24:01] Renalogic - Scott: Yeah. Yeah. So I think Jen, when most people think of dialysis, they think of that experience, right? So it's hemodialysis where, someone has, you know, a fistula in a place in their body, which kind of connects, some veins and arteries. And they go to a dialysis clinic, which you see kind of everywhere, but you know, oftentimes they're in strip malls.
And they sit in a chair, 3, sometimes 4 days a week, every week for, you know, as long as they need dialysis, which is, because it's such life sustaining, it's their entire life. And for 4 to 8 hours, um, they sit in this chair and they have their blood run through a machine that, that literally filters out toxins.
for them. And, this is, you know, to, to put it delicately, like not a pleasant experience. I mean, it is oftentimes a living nightmare, for a variety of reasons. These are people who, you know, they can't work most often because they have to be in the dialysis clinic getting dialized. So it's a really, it's a huge burden on them.
Their caregivers have difficulty holding down jobs because they have to give you know, care and drive these people to the clinic and take them home. It's a painful, almost debilitating experience when you come off the machine. These patients are, you know, highly fatigued. These don't feel good. It is, you know, has been described as a really challenging existence.
And so, if at all possible, I'd urge everyone listening, like, do what you can to avoid kidney disease, certainly avoid end stage renal disease. And I think it's, widely viewed the best possible, treatment for, for most people, assuming all other, things equal is a, is a transplant.
There are other ways to dialyze. There's, what's called peritoneal dialysis, which is when there's a, a fluid injected into the peritoneal cavity. It's just done in a different way than hemodialysis. Not everyone's a candidate for it, requires a little more nuance.
And then there's home dialysis, home hemodialysis, where, someone will have a dialysis machine in their home with all of the requisite fluids, and they're kind of trained in how to self administer dialysis. And so rather than going to a dialysis clinic three or four days a week, they dialyze every single day, every, every night while they sleep, eight to 12 hours.
It's a more gentle, slower process, there's actually less taxing on the body. It has a lot of positives. Quality of life goes up because these people can go out and have a normal life. it's a gentler process, so they feel better over time. I think, complication rates, life expectancies are also, I think demonstrated to improve.
But it's also, you know, it's involved, it requires things like constant access to, certain water, power. It requires a level of training and sophistication that everyone is. is, is comfortable with. Listen, overall, having to be on dialysis is a horrific experience for anyone, and even in the best circumstances, it's not great.
[00:27:13] Renalogic - Jen: We've talked a lot about why we should avoid it, why it's an undesirable situation, and the costs associated with that. Let's talk a little bit about what employers can do to help address some of those costs, and then what Renalogic brings to the table.
[00:27:28] Renalogic - Scott: I think the first thing employers can do is recognize that when it comes to CKD, And end stage renal disease for that matter. It's not a question of if. It is a question of when.As we mentioned before, one in seven adult Americans have chronic kidney disease. If you have members in your health plan who are obese, who have hypertension, diabetes, cardiovascular disease, the chances of them also having chronic kidney disease or developing it while they're on your plan are extremely high.
So it's time to start paying attention. This is not a, a disease that can go, um, left unchecked at this point. And as you mentioned before, it is consistently a top five planned expense year over year for the last 20 years.
It is now time to do something. And the best news I can give you is that chronic kidney disease is a condition that can be, prevented. You can take action, you can do something about it, you can prevent it, you don't just have to manage the risk in the back end. So that's number one. Do something about it, act now.
And this is where Springbuk and Renalogic come in and form this really great partnership where you can detect renal disease early, you can get ahead of the curve, um, and you can kind of risk stratify and project costs going forward. So early detection.
Number two is to use your claims data to your advantage. Obviously, Springbuk is a fantastic platform for that. There are already things Springbuk has baked in the platform that will help surface chronic kidney disease and end stage renal disease risk. If you're a health plan benefits professional, you can navigate over to the activation page and you will see a Renologic analytic that will help you understand your opportunity to save by repricing dialysis claims.
So we have built an analytic that will show you, you know, what your opportunity is to save money on a go forward basis. But you can go several levels deeper than that. As I mentioned before, 90 percent of people who have chronic kidney disease don't know they have it and the tests their primary care doctor is ordering for them on their annual physical aren't helping identify it.
So, early detection, early identification is absolutely critical to helping your health plan members get out in front of their disease, to helping you help them live happier, healthier, better lives, and to saving money by bending the cost trend. And so, with what Springbuk has, and with what Renologic has, and our advanced analytics, we can help you, identify both known and unknown chronic kidney disease risk, including those on your member and your plan who are likely to develop it over time.
And we can provide a hyper-detailed analysis that shows you exactly which plan members are at what stage.
It's helping these members with chronic kidney disease, stage 1 through stage 5, not just the late stage, get a handle on their disease, manage their health. Ideally, it is halting the progression of the disease or slowing the progression of their disease so they can live happy, normal lives for decades.
This is, I think, really important to have kind of a one to one, highly tailored interactions between highly experienced nurses like Renalogic has and individual members. It's one size fits one.
For those members with late stage chronic kidney disease. It's even more specialized care management, so even more specialized nurses on the phone helping them quarterback their care, but it's also a layering in advocacy and patient navigation.
That's everything from helping members enroll in Medicare Part A and Part B, to educating those members on, um, their disease state, and if they're, if they are going to require dialysis, as we discussed, it's helping them understand which of the dialysis modalities in center, at home, peritoneal, and hemodialysis are appropriate for them.
It's helping them get access to transportation, food, and those sorts of things. And maybe the most important, part of this is for member quality of life and health and life expectancy, and for the plan itself is to help those members avoid starting dialysis in the ER or the ICU, which happens 80 percent of the time.
Actuarially, this program has been proven to do two really important things. First, Renalogic's care management program is 98.3 percent effective at preventing the End stage renal disease, chronic kidney failure. So if you're a member that enrolls in this care management program, 98.3 percent of the time, you will not progress to kidney failure.
Second thing for health plans is it's actuarially demonstrated to save $207 per enrolled member per month.
in our enrolled care management program, as well as, about $160,000 in net savings for avoided emergent dialysis starts. So get out there, use your claims, data to your advantage.
The third thing is to reject complacency. So I think far too often benefits professionals have relied on the network discounts that their networks have negotiated with big dialysis. And oh, you know, Cigna, Aetna, the Blues, what have you, United, like they have a rate and we'll just go with that rate and it's better than nothing.
I think what we have found is, first of all, there's so much more to be saved. What we see is that self-funded plans, on average, are paying 700 percent the Medicare rate for dialysis services, which is unjustifiably high, and certainly you could have more, more savings. By putting in place a specific cost containment solution like Renalogic's, a health plan can save somewhere between $100,000 and $300,000 per dialysis member per year, net of fees.
It's massive savings, and as, as a plan size increases, obviously those, those savings rate increases as well. I think it's also important to understand that, your networks actually have a disincentive to negotiate too hard against the big dialysis providers. A lot of moving pieces there, but the bottom line is, um, because the, the networks work with plans on the self-funded side, and the dialysis providers on the self-funded side, as well as MA and fully insured, and because it's duopoly, by negotiating really, really hard on the self-funded side, those networks actually create a problem for themselves, on other areas of their business, and the big dialysis is able to exert a lot some forms of pressure to artificially prop up dialysis rates across the board.
I think the, the fourth thing you can do is is to work with experts in this field. As I mentioned before, the Medicare Secondary Payor Act governs, as does ERISA, it's a highly regulated aspect of healthcare. You need an expert who understands the regulatory landscape, the legal framework around these sorts of things to put a program in place that's that is legally validated, that is rock solid in terms of methodology, and that is nuanced and that can help guide a self run health plan member through all of the plan document amendments and things like that. People can get in a lot of trouble just kind of slapping a multiple of Medicare on and going with the general repricer.
Well, all I think great points to highlight, I think especially your reject complacency component,
[00:35:39] Renalogic - Jen: because I think across the board there's several different components of healthcare that that applies to as well when we think about specialty drugs and when we think about navigation and cancer care and everything else. And I think, to your point, dialysis is one of those. And I think that statistic as far as usually private insurance or commercial insurance is paying, what, 700 percent higher than the Medicare rate.
Because that's how they're getting their money, cause they're not getting it from Medicare as far as with those reimbursements. So someone is making them wealthy. And they'll do that for the 33 months until someone transfers over, to the Medicare payments. I think that's something to be aware of and something to know and know that there are solutions out there that can help.
And then the two components, as you mentioned, the Activate Marketplace that we have now, I do want to highlight as far as for all of our clients within Insights, we do have two Insights cards that highlight two specific conditions that you mentioned. So we do have those that are at risk of developing CKD, which is really important to understand what that future risk is.
And we do have a card for members that do have end stage renal disease. Again, knowing more of what your current risk is, or those that are on dialysis. And then, as you mentioned, it's really easy to flip over into that Activate marketplace. Renalogic is a partner of ours. We run their algorithms, their general algorithms on our client data, so you have a very good understanding of what the impact could be as far as from a cost savings perspective and engagement perspective and the number of members that could potentially qualify for their program.
So that's why we feel so strongly about Activate is knowing that this is data driven. So you get a really good understanding walking into that conversation and knowing, your potential savings there.
[00:37:28] Renalogic - Scott: So much information. I feel like we covered
[00:37:31] Renalogic - Jen: but Scott, thanks so much for talking with us. And if people want to learn more about Renalogic or connect with you, how should they do that?
[00:37:39] Renalogic - Scott: They can see the activation card in Springbuk. They can visit us at www.renalogic.com or any of the links on our resources page to watch, webinars to download case studies, collateral, and send us, messages to request, someone to reach out and talk to them.
[00:37:57] Renalogic - Jen: And of course, if you want to learn more about how Renalogic fits into the Springbuk Activate partner marketplace, please visit springbuk.com/Activate.
And that will do it for another episode of Healthcare on the Rocks: Employee Benefits with a Twist. Be sure to subscribe in your favorite podcast player so you don't miss an episode.
And watch the Springbuk blog next week for additional content about Renalogic and the dialysis market.
[00:38:23] Renalogic - David: And before you jump to the next podcast in your queue, please take a second to give us a nice five-star review, and leave a comment on what you like about the program and want to hear more of in the future. Until then, thank you very much.