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Case Study
How one company used lab data insights to improve population management of chronic kidney disease (CKD)
A value-based care partnership
The Challenge: Proactively identify CKD patients to improve outcomes and control costs
When one of New Jersey’s largest independent physician associations (IPA) entered into a value-based care contract, they intensified their focus on identifying and managing their chronic kidney disease (CKD) population with a few goals in mind:
- Improve patient outcomes. While CKD cannot be cured and the damage it causes is irreversible, diagnosing and treating it early can help reduce complications and control disease progression.
- Control total cost of care. Patients with CKD incur at least two times the medical expenditures of non-CKD patients, especially when the disease goes unmanaged and more intensive–and costly–management is required.1
The physician organization wanted to proactively identify high-risk CKD patients and intervene in a timely manner while gaining further insight into their medical management costs within this population. Claims data alone was not sufficient to generate data to achieve this goal.
The Solution: Overlay proprietary data with claims data
The physician organization turned to Labcorp to help compile proprietary analytics, using Labcorp data, to create a more complete and clear picture of CKD within their patient population. Labcorp began by looking at everyone in the physician organization’s patient population with lab testing ordered from any provider over the past two years, then overlaid the result values with claims data to reveal the true state of CKD. A number of key findings emerged from this analysis:
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Improper coding
Despite the ease of diagnosing and staging kidney disease via routine lab tests, many patients with decreased kidney function weren’t being coded properly or at all. Using the proprietary analytics, Labcorp identified that nearly 80% of patients whose lab results indicated stage 3 CKD carried no CKD diagnosis in the organization’s data.
Few referrals to nephrology
While many of the CKD patients identified were under the care of a PCP or specialist for comorbid conditions (i.e., diabetes, heart disease), few of them were being referred to nephrology for kidney care management. In fact, Labcorp’s analysis indicated that while 30% of Medicare patients had CKD stage 3 or later, test orders from nephrologists accounted for less than 5% of these patients’ lab orders.
Additionally, the marriage of Labcorp clinical data with claims data empowered the physician organization to stratify their CKD population in ways they weren’t able to before, with interactive dashboard reporting to support their population health management:
- High-level view to monitor trends in the overall CKD population and drive appropriate, timely responses
- Drill-down to the individual patient and physician level to identify the at-risk patients who need the most immediate attention and arm physicians with the information to deliver timely care
The Results: Improved quality outcomes
Through its partnership with Labcorp, the physician organization realized significant benefits that better positioned the organization to meet its value-based care goals:
- Improve patient outcomes. Armed with the ability to identify patients whose disease had not yet progressed and those with more advanced disease, the organization was able to focus on patients most at risk for adverse outcomes and offer customized intervention and care, driving improvement in outcomes across the patient population.
- Financial benefits. Closing gaps and resolving inconsistencies in coding significantly impacted financial benchmarks. By more accurately sizing the CKD patient population, the physician organization received more upfront financial support to provide appropriate care management.
- Care management improvements. Armed with both population- and individual-level patient insights, the physician organization was able to establish new ways for physicians and care management teams to collaborate to get the right care to the right patient at the right time.