Ryan Haumschild, PharmD, MS, MBA: Another thing you really hit on was the importance of adherence. If patients aren’t reaching appropriate proportion of days covered, are really they going to have the therapeutic benefit that we’re looking for? And one of the partners that I think about outside of our pharmacy colleagues and our other physician providers is to have a payer that’s supporting that as well. And that makes me turn to Dr Cohen, who is doing a lot of great work around proportion of days covered and payer partnership to ensure adherence. Because as a payer, if you have a number of covered lives and you’re spending money on a benefit, if ICER [the Institute for Clinical and Economic Review] said it’s cost-effective [and] the patient’s not taking it appropriately, then you’re probably not getting that desired ultimate outcome. That’s delaying health care, resource utilization, improving outcomes. So Dr Cohen, when you think about it through your lens as a managed care executive, what payer programs are available to support patients with the prevention and management of CKD?

Ken Cohen, MD: Well, there are programs on the payer side. And then again, as I mentioned before, programs that are contained within a comprehensive, sophisticated medical groups that are providing fully accountable care. I think the latter is more effective because they have direct access to the clinician. Clinicians in general work with a whole variety of payers, and therefore they’re less attentive to any given payer. For example, UnitedHealthcare, our sister company, has a very nice patient education platform for chronic kidney disease. You can direct patients to that and they can learn about the importance of [adherence] and which drugs actually impact lifestyle changes that will impact the course of CKD. So I think that’s one whole part. But the disease management programs that can be contained within a well-functioning medical group or physician hospital organization are critical. You can actually report percent of [adherence]. You can financially incentivize [adherence]. You can use case managers to suggest alterations to therapy. The other thing that we’ve done now, because we’ve got such a large patient population with a bunch of different medical groups that have all coalesced to form a single medical organization, is we’ve created what we call a unified model so that theoretically any of those 22 million patients anywhere in the country seeing any Optum physician is going to get the same CKD care. And that’s important not only in terms of choice of drug but when you get to more nuanced things like what is the point where a PCP [primary care physician] should refer to a nephrologist? Is it 3A? Is it 3B? A well-trained internist who is comfortable managing mineral and bone disorders, looking at phosphate, calcium and parathormone; who is adept at controlling metabolic acidosis—they may be comfortable controlling patients up to 3B and refer. A PCP who is family-trained may not have that same level of comfort and may refer 3A. But creating those guidelines so the treatment is the same, and the referral point is discrete really can benefit patients in the broad.

Ryan Haumschild, PharmD, MS, MBA: Dr Anderson, I want to build upon that, really talking about quality now…. And so we know that the National Kidney Foundation developed new HEDIS and MIPS quality measures to improve the care and the management of patients with CKD and diabetes. Could you discuss what are the implications of these quality measures on patient identification and care? And do you feel like this new focus on HEDIS [Healthcare Effectiveness Data and Information Set] and MIPS [Merit-Based Incentive Payment System] quality measures will improve the way individuals approach care than previously?

Ken Cohen, MD: Well, as Dr Green mentioned, this really isn’t new. You know, we’ve been promulgating this for years. We still have a ways to go. Our uACR [urine albumin-creatinine ratio] screening rates are approaching 80%, which is good. It’s not where it should be. Our hypertension control rates across the organization and some of our groups are as high as 86%, which is great…. Nationally, we’re still struggling to reach hypertension control rates above 50%. So I think that it really is a very broad approach to screening by trying to focus on selective measures and driving improvement just by defining what those measures should be. We’ve been at this for a long time. I think the addition of creatinine is helpful, but I really think it comes down to systems, more than measures; having the systems in place so that irrespective of what the measure is, you can have a case management infrastructure, PCP infrastructure, a specialty PCP, collaborative infrastructure that supports meeting these measurement guidelines across the whole continuum.

Ryan Haumschild, PharmD, MS, MBA: I like that framework for success. Because it’s not just about chasing an individual quality measure, but it’s building that framework of success where then you naturally achieve those quality measures because you have that multidisciplinary team, you have that infrastructure for transitions of care. I think that’s definitely something I’m picking up on as a best practice for our viewing audience as they look to [treat patients with CKD].

Transcript is AI-generated and edited for clarity and readability.