CKD is a major public health concern, affecting over 35 million adults in the United States with as many as 9 in 10 adults not aware that they have the condition. CKD poses a significant health and cost burden to individuals, particularly when the condition is at an advanced stage. The good news — it can be detected early.
CKD often goes undetected due to a lack of early symptoms. If untreated, mainly in individuals with diabetes or high blood pressure, CKD can progress to stages requiring dialysis or a kidney transplant. Several major medical association guidelines recommend the combination of two simple lab tests to assess kidney health: a blood test measuring estimated glomerular filtration rate (eGFR) and a urine test for the albumin-to-creatinine ratio (uACR). Together, these tests, part of comprehensive screening, allow clinicians to diagnose CKD early by assessing kidney function and damage.
Historically, screening rates, especially for uACR, have been low for several reasons, including lack of awareness. CarelonRx was interested in identifying health plan members in need of timely screening. So, CarelonRx partnered with researchers at Carelon Research to understand potential gaps in care and to identify members in need of timely, regular, and complete CKD screenings. Using these actionable insights, CarelonRx looks to partner with life science partners to boost CKD screenings among health plan members.
Researchers at Carelon Research recently analyzed medical claims and related social determinants of health (SDoH) data from 2021-22 to understand the frequency of CKD screening among affiliated health plan members diagnosed with Type 2 diabetes (T2D) enrolled in commercial and Medicare Advantage health plans that covered CKD testing. Of all the patients eligible for screening, 34% had both the required blood and urine tests. Another 46% of eligible patients only had screening tests, usually the blood test, but not the urine test. Of importance, researchers found that 20% of commercial and 10% of Medicare Advantage members had neither of the two tests. Utilizing integrated SDoH data, screening inequities were found by certain socio-demographic characteristics: CKD screening rates were particularly low in older individuals (75-85 years of age), those residing in the Western US, and among Hispanic and Asian populations.
By leveraging data to identify acute geographic disparities, the research team was able to pinpoint zip codes where there were high-risk individuals with subpar CKD screening rates. CarelonRx is now collaborating with life science and medical laboratory partners to reach healthcare providers in these areas, emphasizing comprehensive screenings for these high-risk individuals. Our efforts include telephonic outreach to over 2,000 local providers caring for the non-screened affiliated health plan members, supplying culturally competent educational materials tailored to communicate screening awareness to linguistically and culturally diverse member groups, organizing awareness webinars, and educating provider offices on lab test coding. Additionally, CarelonRx is partnering with a national renal health organization to raise awareness through social media.
CarelonRx and Carelon Research aim to continuously evaluate the results of these targeted efforts to understand our impact on reducing the gaps in care and to further enhance future outreach efforts to non-screened affiliated health plan members and their providers. This coordinated approach may lead to increased CKD screening rates, resulting in better patient outcomes, lower long-term costs, and lives saved. Here are three key takeaways that underscore the importance of advocating for comprehensive CKD screening protocols:
- Increase early screening and detection with a goal to improve patient outcomes: The 2020 United States Renal Data System annual report highlights that up to 40% of patients with Type 2 diabetes have CKD, with nearly 90% unaware of their condition. Inadequate comprehensive screenings may allow CKD to progress undetected, which may ultimately impair kidney function. Albuminuria — a condition where high levels of the protein albumin are found in the urine — is a sign of kidney disease and, is a marker for CKD progression. Testing urine for uACR along with an eGFR blood test allows for early detection of CKD. Our data showed about half of screening-eligible patients did not undergo the urine test. By improving screening practices with both urine and blood tests, patient outcomes can be improved while reducing healthcare costs.
- Increase provider awareness and drive early diagnosis and treatment: Early detection of CKD at stages 1 or 2 can facilitate the initiation of treatment approaches that can potentially slow or halt disease progression. High-risk patients most often visit a primary-care setting. Therefore, primary care physicians (PCPs) play a vital role in the early detection and management of CKD. Educating and enabling PCPs to incorporate blood and urine tests in routine examinations of high-risk patients helps in diagnosing and treating CKD in its early stages, leading to better outcomes.
- Early detection may improve outcomes and reduce costs: The economic impact of CKD is significant. Data shows that the one-year cost burden for patients with both CKD and Type 2 diabetes increases by CKD stage ranging from $29,993 to $41,222 for those in stages 1-3a and from $46,796 to $119,944 for those in stages 3b-5. Early detection and treatment will help delay the progression of disease state leading to lower costs and better patient quality of life.
This March, in recognition of National Kidney Month, we invite you to join us in raising awareness about the importance of kidney health and the need for comprehensive and timely screening to promote higher quality and more affordable healthcare in our communities.
Hani Sefain, PharmD, is trade relations director at CarelonRx; and Nilesh Gangan, PhD, is a researcher and part of the pharmacy economics team at Carelon Research, a part of Elevance Health.
