ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-OR21

Associations Between Enrollment in ESRD Special Needs Plans and Outcomes

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Becker, Bryan N., DaVita Integrated Kidney Care, Denver, Colorado, United States
  • Luo, Jiacong, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Gray, Kathryn S., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Colson, Carey, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Cohen, Dena E., Davita Clinical Research, Minneapolis, Minnesota, United States
  • McMurray, Stephen D., DaVita Inc, Denver, Colorado, United States
  • Gregory, Bryan Wayne, DaVita Integrated Kidney Care, Denver, Colorado, United States
  • Lohmeyer, Nathan, DaVita Integrated Kidney Care, Denver, Colorado, United States
  • Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
Background

Chronic condition special needs plans (C-SNPs) are Medicare Advantage plans that offer care coordination and specialized services for patients with conditions such as end-stage renal disease (ESRD) via specific benefits packages and provider networks. Although ESRD C-SNPs have been offered for over 10 years, an understanding of their impact on patient outcomes is lacking.

Methods

This observational study considered dialysis patients receiving care at a large dialysis organization who enrolled in a C-SNP from January 2013 to September 2017; study data were derived from deidentified medical records. As of C-SNP enrollment date (or matched date for controls), enrollees and controls were matched on the basis of index month, sex, race, etiology, and dialysis modality, as well as a propensity score. Eligible controls were patients who (separately): 1) dialyzed in the same facility as the C-SNP patient but had not enrolled in the C-SNP; 2) dialyzed in counties with no C-SNP but that were otherwise socio-demographically similar to C-SNP counties. Outcomes were evaluated from enrollment date through the first of study end (31 Dec 2018) or censoring for death, insurance change, or loss to follow-up. Within each matched cohort, outcomes were compared using generalized linear or Fine and Gray subdistribution hazard models.

Results

Hospitalization rates were 10% to 24% lower among C-SNP enrollees compared to controls, with an incidence rate ratio of 0.90 (95% confidence interval [CI] 0.84, 0.97) for patients in the same facility and 0.76 (95% CI 0.70, 0.83) for patients in similar counties. The mortality rate for C-SNP enrollees was approximately 23% lower than that of controls, with a hazard ratio of 0.77 (0.68, 0.88) for patients in the same facility and 0.77 (0.68, 0.88) for patients in similar counties. No meaningful differences were observed between groups with respect to serum calcium, phosphate, potassium, parathyroid hormone levels, or Kidney Disease Quality of Life scores.

Conclusion

C-SNP enrollment is associated with markedly lower rates of hospitalization and mortality, compared to non-enrollment.