Middle-aged man being examined by a female doctor in a doctor's office. Patient complains to the doctor of kidney pain.

Seniors with end-stage renal disease (ESRD) could become a burden on Medicare Advantage plans, possibly forcing some MA plans to trim supplemental benefits, including home care. Policy and health plan experts at healthcare innovation firm Avalere made that assessment during a recent webinar

Matt Kazan, a principal in Avalere’s policy practice, said the number of ESRD patients in Medicare Advantage plans is about 30% and growing. Kazan estimated those beneficiaries cost MA plans up to nine times more than other beneficiaries, yet Medicare payment rates to MA plans for that cohort are lower than those to fee-for-service plans in many parts of the country.

“In many cases if a plan is paid inadequately for ESRD patients, they have to make adjustments to their larger benefits package — say supplemental benefits — for all of their enrollees to make up for that difference,” Kazan explained in the webinar. 

The cost of kidney disease

Kidney disease increasingly is becoming an expensive problem for the Medicare system. About 1 in 3 adults is at risk of developing kidney disease, and an estimated 800,000 seniors have ESRD, requiring dialysis. Those patients make up about 1% of Medicare beneficiaries, but account for about 8% of total Medicare costs. 

A handful of new companies, including kidney disease care firms  Cricket Health and Strive Health are partnering with MA plans and accountable care organizations to identify kidney disease earlier and move more patients into home dialysis once they progress to ESRD. 

David Sund, Strive Health’s senior vice president of payor partnerships, told McKnight’s Home Care Daily Pulse in an email the company aims to increase home dialysis among its partner beneficiaries to more than 40%. The company is also leveraging telehealth and deploying special teams to ensure kidney patients get the care they need to keep the disease in check.

“Patients that are in rural areas or may have certain social vulnerabilities can benefit from the use of telehealth and telemedicine services,” Sund said. “Patients may prefer virtual care, which Strive will readily accommodate.”

Policy changes could also help move the needle on kidney care. Advocacy groups are lobbying the Centers for Medicare and Medicaid Services for more flexible rules that would make it easier for patients to learn how to dialyze at home. Kazan suggested CMS also could increase the payment rate on ESRD patients to help cover the cost of care for MA plans.