Team-based care improves care for kidney disease, reduces costs by $1.2 million

Costly condition expected to grow as population ages

ST. LOUIS PARK, Minn. — A Park Nicollet program to improve care for more than 100 patients with end-stage kidney disease improved the quality of care and decreased costs by more than $1 million last year.

To survive, patients with this disease must have a kidney transplant or dialysis. Dialysis needs to be performed multiple times each week to remove waste from the body. The cost for this care accounts for 7 percent of Medicare spending.

To improve care and lower costs, Park Nicollet created a special care team to support patients. The team works with a kidney specialist. It includes a nurse care consultant, a nurse care coordinator and a medication therapy management (MTM) pharmacist.

“This is a great example of how we can change the way care is delivered so that it provides better value,” said Rajeev Kaul, MD, Department Chair for Nephrology at Park Nicollet. “Better care not only improves the quality of life for patients, it also lowers the cost of care.”

Reduced hospital admissions, emergency department visits

The care consultants reduce barriers to care such as transportation. They also help coordinate care. The care coordinator regularly follows up with patients after they leave the hospital. This ensures that patients know how to take medications correctly and that they get all of the recommended care. Patients who received these services had 50 percent fewer emergency department visits and 69 percent fewer hospital admissions within six months.

Many patients taking an average of 17 medications each day. MTM pharmacists identified an average of three problems per patient. The most common problems were:

• A drug was not working as expected
• A drug had unsafe interactions with other medications
• A different drug was needed

In addition to improved care, MTM visits increased patient satisfaction and reduced costs by 35 percent. As a result of this success, Park Nicollet is expanding this program to other patients, such as those with chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD).