Economic and Clinical Outcomes Resulting From the Stage 4 Chronic Kidney Disease Case Management Quality Improvement Initiative.

Beverly Everett Liana D Castel Matthew McGinnis Amy Beresky Rudolph C Cane Tasha Cooper Rajesh K Davda Donna Farmer Stella M John Denise L Sollars John F Rausch

Prof Case Manag

Beverly Everett, MD, FACP, holds an MD degree from Tufts University School of Medicine, completed her Internal Medicine residency and Nephrology Fellowship at the University of North Carolina at Chapel Hill, practiced medicine for 15 years before joining Cigna, and after 18 years retired in 2015. Liana D. Castel, PhD, is Editor-in-Chief of Patient Related Outcome Measures (Dove Medical Press, Ltd), Adjunct Professor at the University of Mount Olive Tillman School of Business, and medical writer at Cigna. She holds a PhD degree from the University of North Carolina at Chapel Hill. Her research interests include outcomes and statistics. Matthew McGinnis, BS, has been with Cigna more than 13 years and leads the analytics team supporting Cigna's pharmacy benefits management business. He holds a US Patent for an End of Life Predictive Model, a Master of Science degree from Northwestern University, Illinois, and Certificate in Public Health from University of Florida. Amy Beresky, MS, holds a Master of Science in Statistics degree from University of Massachusetts Amherst. She has 8 years' experience in health care data mining, analytics, and predictive modeling, supporting Cigna's clinical programs, is fluent in Spanish, and has served on the Board of Directors and Environmental Committee in the residential community. Rudolph C. Cane Jr., MD, is Medical Director for Cigna Healthcare, Department of Clinical Performance and Quality. He holds board certification in Internal Medicine, completed Internal Medicine residency at Franklin Square Hospital Center, surgical internship at St. Agnes Medical Center, Baltimore, MD, and holds an MD degree from the University of Maryland School of Medicine. Tasha Cooper, RN, is a registered nurse who has been employed by Cigna for more than 20 years, holding various roles in the areas of Clinical Program Development, Case Management, Utilization Management, Disease Management, and Quality Accreditation and Compliance. Her career also includes more than 8 years of hospital and home health nursing experience. Rajesh K. Davda, MD, is the National Medical Director for network performance and quality improvement at Cigna Healthcare. Dr. Rajesh is board certified in internal medicine, nephrology and clinical informatics. Before joining Cigna in 2012, Raj was in private practice for 22 years in South Carolina and Texas. Donna Farmer, BSN, RN, CCM, has a clinical background in managing catastrophic illness and life care planning. She has been employed at Cigna since 2001 where she has worked as a case manager (CM), CM supervisor, and clinical program consultant. Stella M. John, BSN, RN, started at Cigna in 2005 as a catastrophic case manager and chronic condition kidney case manager. Currently, she holds the position of clinical coach with Cigna Workforce Development. Her 19 years' clinical experience includes surgical and medical ICU with a cardiac focus and intermediate care unit manager. Denise L. Sollars, BSN, RN, CCM, began her career with Cigna in August 2001. She is a certified nurse case manager and was part of the Case Management team for 12 years. She is currently a clinical consultant for the Mid-America Market. Before joining Cigna, Denise had 15 years' hospital clinical experience. John F. Rausch Jr., MD, FACP, FNKF, is board certified in Internal Medicine, has served as Board of Directors Chairman, National Kidney Foundation of Arizona, founding member and current Board of Directors member, Cardio Renal Society of America, and Medical Director at Cigna, Clinical Performance and Quality, Total Health and Network.

Published: September 2018

Purpose Of Study: Chronic kidney disease (CKD) is a costly and burdensome public health concern. The goal of this study was to evaluate the impact on outcomes and utilization of a pilot program to identify and engage beneficiaries with CKD at risk for progression from Stage 4 to Stage 5.

Primary Practice Settings: A quality improvement initiative was conducted to assess the impact of case management on costs and outcomes among 7,720 Cigna commercial medical beneficiaries with Stage 4 CKD enrolled in the United States between January 2012 and October 2012.

Methodology And Sample: Claims data were analyzed to compare 3,861 beneficiaries randomized to receive condition-focused case management with 3,859 controls, with follow-up through July 2013. After using an algorithm to identify beneficiaries at highest risk of progression, a case management team implemented, among those assigned to the intervention, an evidence-based assessment tool, provided education and follow-up, engaged nephrologists and other providers, and conducted weekly rounds. Primary outcome measures were hospital admissions, emergency department visits, nephrologist visits, dialysis, arteriovenous (AV) fistula creation, and total medical costs. Analysis of variance techniques were used to test group differences.

Results: As compared with controls, intervention beneficiaries were 12% more likely to have fistula creation (p = .004). Intervention beneficiaries were observed to have savings of $199 per member per month (PMPM), F = 23.05, p = .04. This difference equated to 6% lower total medical costs in the intervention group. Savings observed were derived half from improved in-network utilization and half from reduced hospital costs.

Download full-text PDF	Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5636199	PMC
http://dx.doi.org/10.1097/NCM.0000000000000253	DOI Listing

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