Early screenings benefit kidney disease patients
Early screenings benefit kidney disease patients
Case managers educate members face to face
A case management program for members with chronic kidney disease provides one-on-one education that helps members of U-Care Minnesota manage their comorbid conditions and make lifestyle changes that slow the progression of the disease.
The KidneyCare program is a collaboration between U-Care and a local nephrology group, Kidney Specialists of Minnesota, which developed the program and provides the case managers who work with patients coming to their clinic, says Jodie Milner, RN BSN, U-Care's manager of disease management.
"We wanted to go with the model of using a provider specialist as a vendor. This way it keeps the primary care provider in the loop and ensures that a nephrologist intervenes with the member at an early stage," she adds.
The KidneyCare program promotes early screening for kidney transplants and early surgery to create a fistula or a graft for vascular access if it's determined that the member ultimately will have to have dialysis, Milner says.
"The vascular access of choice is a fistula, which takes several months to mature. It is essential that members have the fistula in place several months before they need dialysis," she says.
The other type of dialysis access, a "permacath," which is used mainly for starting emergency dialysis in a hospital setting, can cause complications such as sepsis and is not desired for long-term use, Milner says.
Since the KidneyCare program began in 2003, about 180 members have enrolled. All of the members enrolled have had a discussion with their physician about early-access placement for dialysis and have been assessed for transplant status.
Among members who have a hemoglobin count of less than 11, 98% meet criteria for the National Kidney Foundation's Kidney Disease Outcome Quality Initiative for anemia control by having vascular access put in early.
Before U-Care started the program, the majority of members saw a nephrologist for the first time when they were hospitalized for kidney failure and needed to start dialysis immediately.
"In this kind of instance, there is no time to put a dialysis fistula in place or screen the member for a transplant. The costs were high. When members are enrolled in the chronic kidney disease program early, there is more time between diagnosis and dialysis, and this allows for better and more cost-effective care," Milner says.
Getting members into the program early helps them learn to control co-morbidities, such as hypertension, which starts to cause kidney damage over time unless it is under control. The same thing is true for diabetes, which causes kidney damage unless the member's hemoglobin A1C is under control.
"The program is preventative as well as helping the members manage their disease," Milner says. When people are assessed for a kidney transplant early, they have a better likelihood of finding a donor.
"The costs for transplantation are high but after two to three years, it's equal to the cost of dialysis," she says.
Dialysis typically costs several thousand dollars a month, she adds.
U-Care Minnesota identifies eligible members from a claims search of kidney-related diagnoses. The health plan sends a list of potential participants to primary care providers and asks providers to screen patients for eligibility, and then refer them to the program if appropriate.
Members must have a glomerular filtration rate (GFR) of less than 60 and must have the approval of their primary care physician to participate in the program.
When members are referred to the program, a nurse case manager (KidneyCare nurse) from Kidney Specialists of Minnesota contacts them and sets up an appointment if the member agrees to enroll. On the first visit, the member sees the nephrologist who confirms the diagnosis. After that, he or she sees the KidneyCare nurse, who specializes in renal diseases. The KidneyCare nurses conduct an assessment every time they see patients and continuously screen them for eligibility for transplants.
The KidneyCare nurses refer members to other programs and providers from which they could benefit, such as smoking cessation programs or a renal dietician consultation. They encourage members to bring their family members to a class that includes an overview of kidney disease and the various types of dialysis, access types, dialysis options, and transplantation education.
They can refer members to a transplant program in conjunction with the nephrologist and to a vascular surgeon for an appointment to create a vascular access point for dialysis.
The KidneyCare nurses are a resource for U-Care members and their families whenever they have questions about kidney health, Milner says.
"One-on-one education is a big component of the program. When they visit the KidneyCare nurse, the members get high-quality one-on-one time with a clinician who understands their disease and can educate them and help them manage it," Milner says.
The members come into the office regularly to see the KidneyCare nurse who covers basic facts on chronic kidney disease, ways to slow its progression, and manage co-morbidities. The nurse educates the member on lab values and what they mean, stresses the importance of getting blood pressure or diabetes under control, and talks about ways to protect veins for future dialysis, she says.
The frequency of visits is determined by which stage the patient is in. Stage 1 means minor kidney dysfunction; people in Stage 5 are heading for dialysis.
"Most members are enrolled when they are in Stage 3. The frequency with which they see the KidneyCare nurses will escalate as their condition worsens," she says. The members see the KidneyCare nurses mostly for educational purposes.
The health plan notifies the KidneyCare nurse when members in the program are hospitalized so the members can receive post-hospitalization follow-up care.
U-Care works with the nephrologists and primary care physicians to collect and share data and to track the members' progress.
"The nephrologists and primary care physicians have established good relationships and they collaborate for good patient care. Proactive change is much easier if all the partners work together," she says.
A case management program for members with chronic kidney disease provides one-on-one education that helps members of U-Care Minnesota manage their comorbid conditions and make lifestyle changes that slow the progression of the disease.Subscribe Now for Access
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