Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are common and costly conditions that affect millions of Americans.
Through disease management and dialysis network access, Optum helps address these health concerns with excellent clinical and economic outcomes.
A comprehensive solution
The Optum specialized kidney support team improves the quality of life for James
Chronic kidney disease (CKD): Common, complex and costly
CKD is progressive and often evolves slowly with few symptoms. As the disease progresses, the prevalence of other simultaneous conditions such as diabetes, hypertension and cardiovascular disease increases.1,2,3
More than 15 percent of American adults -
more than 30 million
people - have CKD and
many others are at risk4,10
leading cause of
death in America5
86 percent with
have at least one
mortality rate in the
first year of dialysis7
Over $50 billion
spent on treating SRD patients
in the United States in 20098
more expensive to treat
ESRD patients on dialysis
compared to the cost of
treating transplant patients9
Identification and treatment
Early engagement is critical for managing kidney disease. Asymptomatic in the early stages, nearly 90 percent of adults with CKD are unaware they have the disease.10
Through our proprietary blend of curated data, analytics and expertise, we scrutinize claims and lab data to identify and engage employees before their kidneys fail and dialysis becomes necessary.
It also allows us to prioritize individuals with deteriorating conditions. Early identification also enables us to educate them on preemptive transplantation, which has been shown to have the best outcome.
Comprehensive Kidney Solution (CKS) is our disease management solution. CKS is comprised of two integrated, evidence-based condition management programs to help manage these conditions:
CKD stages 4/5: Pre-dialysis program focusing on delaying disease progression and preparing individuals for renal replacement therapy.
ESRD: Program to manage the population on dialysis, which is characterized by frequent hospitalizations and multiple comorbidities.
CKS enables excellent clinical and economic outcomes for both CKD and ESRD. Proven results translate into material savings and improvements in quality of life in the months preceding initiation of dialysis.
reduction in inpatient
reduction in ER visits12
less likely to initiate
less likely to transition
from CKD to dialysis14
CKD stages 4/5 pre-dialysis program
Our licensed, dedicated renal care management specialists work one-on-one with the patient, in nearly 500,000 engagements annually, from stages 4 and 5 through ESRD.
The program also supports and educates the patient, leading to informed decisions as the disease progresses.
Our program ensures that individuals in stage 4 and 5 are referred to a nephrologist, a critical component of their care.
We work with providers and caretakers to help patients on dialysis receive appropriate care.
We focus on mitigating risks due to the underlying cause of renal failure and those related to ESRD, including cardiovascular disease, anemia, poor nutrition and depression.
Our holistic approach means that our renal-trained nurses focus not only on the clinical, but also on the social and financial implications of ESRD.
Dialysis network access
The Optum kidney dialysis network maximizes accessibility, outcomes and savings. We partner with top dialysis centers across the nation to provide needed quality care at negotiated rates.
Access to the more than 6,100 dialysis centers can reduce dialysis costs by an average of 55 percent, ranging from 35 to 70 percent.
In situations where patients cannot conveniently access a contracted dialysis center, we will negotiate patient-specific agreements or use partnership agreements with PPO networks to get the best possible discount.
- More than 6,100 dialysis center locations nationwide including Fresenius and DaVita
- 99 percent of centers are Medicare-certified
Network status as of July 2018. Maps are continually updated and subject to change without notice.
Managed Kidney Program
Optum Managed Kidney Program manages the clinical aspects and financial risk of your kidney disease cases so you can be protected from volatile ESRD costs. Simply pay a standard monthly premium.
The Managed Kidney Program is a fully insured risk solution for ESRD. This disease management program closely manages care for members in CKD Stages 4 to 5. It also reinsures ESRD on a population basis, covering all medical benefit expenses for members in ESRD.
This total cost of care starts for ESRD members when the member initiates dialysis and ends with the month of member death, plan eligibility term, or month before transplantation (unless bundled with the Optum Managed Transplant Program).
Health plans retain contracts and claims while Optum wraps value as needed on dialysis network.
With this unique carve-out program health plans can:
- Decrease cost volatility. Fixed premiums negate the unpredictable costs of inpatient admissions, readmissions, ER visits and specialty visits that often come with kidney disease.
- Limit claims exposure. The program reinsures on a population basis, protecting you from changes in prevalence and utilization.
- Reduce management of complex cases. Late-stage CKD and ESRD cases are managed by a team of specialized Optum kidney nurses who provide members with individualized plans of care.
1, 10National Institute of Diabetes and Digestive and Kidney Diseases, 2009 ESRD Statistic. Accessed: 11/13/2018.
2United States Renal Data System (USRDS) 2014, Vol. 2, intro, pg. 80, Table i.1, Figure 1.10 Accessed 11/13/18.
3James P. Boyle, PhD, Amanda A. Honeycutt, PhD, K.M. Venkat Narayan, MD, Thomas J. Hoerger, PhD, Linda S. Geiss, MA, Hong Chen, MS and Theodore J. Thompson, MS, Diabetes Care, American Diabetes Association, November 2001 vol. 24 no. 11 Accessed 11/13/2018.
4, 10Source: National Kidney Foundation
5Centers for Disease Control and Prevention, National Center for Health Statistics. Deaths: Final Data for 2011. Accessed 12/6/2017. 6.Gullion CM, Keith DS, Nichols GA, Smith DH. Impact of comorbidities on mortality in managed care patients with CKD. Am J Kidney C. 2006.
7U.S. Renal Data System. USRDS 2010 Annual Report; 2:219. Figure P18IL.
8, 9National Institute of Diabetes and Digestive and Kidney Diseases; Kidney Disease Statistics for the United States
10(same as #1)
11Optum Healthcare Analytics CKD Program analysis for Large and Small Employers comparing Program Eligible Members to Non-Eligible Members, 2016.
12UHG Health Economics study completed in 2016 compared matched ESRD patients in Medicare Advantage policies with and without CKD management. Results are year 2 Difference in Difference measures
13Optum Healthcare Analytics study completed 2017 comparing Commercial CKD 4-5 Program Participants vs. Non Participants.
14Optum Healthcare Analytics (HCA) CKD to ESRD Transition Analysis, 2016.