Network based systems

[email protected]: Affordable Networked Care for End-Stage Kidney Disease…

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Almost 800,000 American adults live with end-stage renal disease (ESRD). A recent CDC report found that between 2000 and 2019, new cases of ESRD increased by 42% and the number of people living with this stage of the disease nearly doubled. ESRD is a form of chronic kidney disease characterized by a gradual loss of kidney function over a period of months to years that progresses to the point where the kidneys no longer work properly. As a result, dangerous levels of fluids and waste build up in the body, leaving dialysis or a kidney transplant as the only treatments available.

Dialysis usually involves connecting a patient to an artificial kidney to do the filtering (called hemodialysis), although another type of dialysis (peritoneal dialysis) uses the abdominal lining to filter the blood inside. ESRD is unique within the U.S. health care system because it was the first—and for decades, only—health condition for which Congress authorized diagnosis-based Medicare coverage. In addition to being eligible for Medicare, many people living with ESRD are also enrolled in employer-provided coverage.

A recent analysis by AHIP’s Center for Policy and Research found that nearly all dialysis treatments are covered as in-network procedures by group health plans. All dialysis service codes were treated as in the network 95.3% of the time, for example, according to the review of dialysis requests for the calendar year 2020.

Employer-provided health plans typically include substantial coverage of dialysis services for people with ESRD. With over 95% of dialysis treatments available in the network, employer-provided coverage ensures people with ESRD have access to the routine dialysis they need from responsible, high-quality providers and lower cost.

Earlier this year, AHIP replied
to a Federal Request for Information (RFI) on ESRD facilities, in which AHIP offered real solutions to improve care for chronic kidney disease. Beyond these recommendations, coverage at work remains a key tool to ensure safe, reliable and affordable dialysis.

Employer-provided coverage provides extensive and generous coverage of kidney dialysis services and treatment for people with ESRD and other forms of kidney disease – it’s in the best interest of employees and people with charge. As with other chronic conditions, by prioritizing high-value, patient-centered care for chronic kidney disease and ESRD, health insurance providers, employers, and healthcare providers can facilitate more affordable care and result in better health.

With over 95% of dialysis treatments available in the network, employer-provided coverage ensures people with ESRD have access to the routine dialysis they need from responsible, high-quality providers and lower cost.

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