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Abstract: FR-PO442

Managed Care Program Improves Hospitalization Rate in ESKD Patients

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis


  • Walker, Adam G., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Sibbel, Scott, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Marlowe, Gilbert, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Roer, David A., DaVita Inc, Denver, Colorado, United States
  • Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States

Care fragmentation, a lack of coordinated care for patients, is associated with reduced quality of care, increased costs, and poor clinical outcomes. End stage kidney disease (ESKD) patients are at increased risk of care fragmentation due to the complex collection of conditions that often accompany ESKD (i.e., diabetes, hypertension, etc.) and require care from multiple healthcare providers. Recently, managed care programs have started to defragment care for ESKD patients through collaboration across healthcare organizations in order to improve clinical outcomes. However, whether and to what degree these programs are effective is unknown.


This was a retrospective, observational study of dialysis patients with commercial or Medicare Advantage insurance treating with a dialysis provider in the United States from June 2021- June 2022. The primary exposure was enrollment in a managed care program. Expected hospitalization rates for enrolled patients were estimated by indirect standardization versus the non-enrolled patients.


After accounting for differences in age, comorbidities, insurance type, and geography, we observed that enrolled patients had 0.11 admits per-patient per-year favorable hospitalization rate compared to non-enrolled patients. This resulted in an estimated 961 hospitalizations prevented among approximately 8,500 enrolled patients during the study period. Hospitalization reduction was similar between managed care programs done in partnership with government and private insurers.


A provider managed integrated kidney care program can be effective in improving clinical outcomes for ESKD patients for public or private payors.