Managing ESRD Patients: One ACO Shares Its Strategy

Managing patients with chronic diseases has been a big focus for many accountable care organizations, since those patients traditionally use healthcare facilities more often than patients with no chronic disease.

Some chronic diseases require more management, meaning patients see specialists more often than others. Patients with end stage renal disease, for example, typically are healthcare super-users. "ESRD patients are amongst the most needy and the highest cost patients in the population," says Jonathan Gluck, senior executive with Heritage Provider Network, which runs the Heritage California ACO, a Pioneer ACO based in Northridge, Calif.

In fact, nationwide, ESRD patients make up only 1.3 percent of Medicare patients but account for 7.5 percent of annual Medicare spending, according to the United States Renal Data System's 2012 report.

The high-use, high-cost nature of ESRD patient care is why Heritage decided to partner with Waltham, Mass.-based Fresenius Medical Care, the nation's largest provider of kidney care services, to provide integrated care management of the ACO's ESRD patients.

Talks between Heritage and Fresenius began in 2012, and the partnership formally began Jan. 1, at the start of the 2013 Pioneer ACO performance year.

How it works

Very broadly, Fresenius nephrologists have signed up to be part of Heritage's ACO, so ESRD patients going to area Fresenius nephrologists are attributed in the ACO model to Heritage. Then, the two groups work together to coordinate the care of the ESRD patients, whether the care is provided in a Heritage ACO facility or a Fresenius facility.

"We're good at managing inpatient hospital care and getting excellent results and quality outcomes," says Mr. Gluck. "Fresenius is good at managing dialysis of ESRD patients. We can use both of our methodologies to bring lower cost, higher quality care to ESRD patients being served by the ACO."

To more closely coordinate care with one another, Heritage ACO gave Fresenius access to its enclosed, self-contained ACO management electronic medical records system, which includes patient data, care management plans and patient communication tools.

Future plans

According to Mr. Gluck, Heritage ACO is open to "all partnership opportunities" when it comes to managing other chronic disease patient populations. But for now, the ACO is happy with how the partnership with Fresenius is going.

"The partnership is really a model of how ACOs can work best, taking highest need population that can have care significantly improved in coordination and save Medicare significant amounts of money," Mr. Gluck says. "You can take a high cost, difficult to manage population and give them better care through coordination…and at the end of the day provide a better care experience and outcomes for a traditionally hard to manage population."

More Articles on ACOs:

ApolloMed ACO Partners With Fresenius for ESRD Patient Care
ACOs: The State of the Union
Specialty ACOs: The Next Step in Accountable Care

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