We recently held a webinar with Dr. Navdeep Tangri, the Canadian nephrologist and medical researcher who developed the Kidney Failure Risk Equation for accurately predicting the risk of progression to renal failure in patients with chronic kidney disease (CKD). Below is an excerpt from the presentation.
Viewics has implemented the Kidney Failure Risk Equation (KFRE), as well as the Viewics care protocol, in our product, Viewics CKD Management™. As Dr. Navdeep Tangri and Dr. Eleanor Herriman have previously stated, different risk scores suggest different solutions for patients with CKD. A risk score above xx% over five years is when a primary care physician (PCP) should refer to a nephrologist. Above yy% over two years — that’s when we start talking about a multi-disciplinary clinic and hospital support. Ultimately, this is what ends up driving the cost savings: appropriate care for the people who have been identified as progressors.
Viewics has an automated platform in the back end that allows for the collection of all of these variables from the LIS and the EHR, in order to automate all of these for a hospital system or ACO-wide population.
Introducing a comprehensive CKD management solution
We have several different views, the first one being a physician view, shown below. This is where the primary care physician can see all of the patients that he or she is caring for, and their risk of progressing within two to five years. Again, based on that care protocol, we’re able to offer decision support to allow the physician to decide when it’s appropriate to refer to the nephrologist, and when it’s inappropriate as somebody’s identified as a non-progressor to keep caring for them as a primary care physician. As you can see at the top of the dashboard below, there are alerts on high-risk patients who have yet to be referred, and that flows from the EMR data.
Additionally, we have a nephrologist view (pictured below) that shows how patients have been traditionally staged, their most current and previous risk score calculation, and the trends — has this person progressed more rapidly than others? From there, those are grouped into buckets and appropriate care is suggested, whether that be discussing multi-disciplinary hospital support, or talking about an arteriovenous fistula. As we’ve talked about before, each of these things ultimately offers better outcomes for the patient with lower cost and slows progression in a lot of cases.
We have found is that there’s a high level of anxiety for patients when they are diagnosed with CKD. For that reason, we also provide an individual, personalized patient report (see example below) that talks about the disease, the patient’s chance of progressing, where he or she would be traditionally staged, what to think about and worry about, and what not to worry about in the future, as well. We have found that this report reduces patient anxiety and actually increases their follow-through with treatment.
Ultimately, this all rolls up into an executive dashboard (pictured below) for the people running the CKD programs within ACOs and multi-hospital systems. This is where one can measure how many of your primary care physicians are following the care protocol, how many of your nephrologists are following the care protocol. The ability to see statistics of how many patients within the system have what stage of the disease and chance of progressing. And, ultimately, that’s what drives the cost savings across the entire network.
The benefits of accurate risk prediction
The Viewics CKD Management program offers much more accurate risk prediction than glomerular filtration rate (GFR). GFR has been used for several decades for staging, but there’s no way to determine who will progress. There are stage 4s who won’t progress; there are stage 3s who will progress faster. Ultimately, we need to be able to decide what the best care is for each of those patients.
Earlier nephrologist care allows for fewer emergency entries into the system. There are fewer emergency crashes. It adds more patient choices, and ultimately lowers costs and provides better outcomes. In many cases, the care protocol itself allows us to slow progression of the disease from 3a to 3b to 4. And the personalized patient report, again, lowers the patient anxiety and increases patient satisfaction across multiple systems.
Expected savings for health systems
So, what does that mean for us? In the grand scheme of things, what we can expect to save as a health system? By being able to delay stage 3 progression, we’ve seen about $800,000 in yearly savings for a health system with a population of 25,000 or more. That’s not 25,000 CKD patients; that is covered lives in general. By being able to classify stage 4s and treat them as stage 3s — those are the people who are non-progressors — we’ve been able to see about $1 million in savings yearly. And again, earlier nephrologist care for pre-renal failure drives around $200,000 in savings per year, which helps by decreasing the necessity for dialysis or transplants. So, again, for a health system with 25,000 covered lives, the literature has shown about $2 million in savings yearly by using this program.
Watch the on-demand webinar: Revolutionizing Renal Care with Predictive Analytics for CKD.