The status quo of kidney care has several weaknesses that reduce the success of care plans: late diagnoses, failure to engage patients in care, lack of attention to social barriers to care, and unplanned dialysis starts.

The new world of kidney disease as envisioned by kidney care managers zeroes in on early detection and patient engagement to address poor outcomes, negative experiences, and high costs associated with ESRD.

Overview and methodology

We assessed kidney care managers across 12 criteria that fell into three categories:

• Patient appeal: The disruptor impacts the preferences and choices of end users through
  better accessibility, experience, affordability, or perception of positive clinical outcomes.
• Business opportunities: The disruptor has expansion opportunities and potential competitive advantages due to its ability to enter new markets, access capital, form partnerships, coordinate internally, and leverage existing strategic assets.
• Innovations: The disruptor identifies and deploys novel staff, technology, processes, and delivery channel tactics to produce greater efficiencies, lower cost structures, or improve operating performance compared to the status quo.

We scored each of the 12 evaluation criteria on a scale of 1 through 4. We based the scores on our interviews and analysis. Each score reflects relative strengths and weaknesses.

Disruptor capabilities: Score breakdown

The following graph highlights where kidney care managers hold the competitive edge over incumbents. Each section is made up of subcategory scores. Those subcategories where disruptors score a 3 or a 4 indicate highly competitive and differentiating features, whereas a score of 1 or 2 indicates less unique or lower priority features.

See below for a scoring breakdown of the disruptor.

Disruptor Assessment: High disruptive potential to incumbents 

Digitally enabled kidney care managers offer clinicians the ability to detect renal disease earlier and provide diagnosed patients with more convenient and connected care. Kidney care’s relatively high per member per month (PMPM) reimbursement rates and projected increase in prevalence makes kidney care an attractive condition group for value-based care contracts. Continued interest from external actors to both fund and partner with these care models pose a real threat to incumbent care models which provide in-person, facility-based care.

Business opportunities

Kidney care platforms have partnered with major payer and provider groups, merged with key kidney care companies, and secured large amounts of funding through proving return on investment (ROI) and clinical outcomes in early stages of product deployment. They are entering new markets where large swaths of the population with kidney disease remain unmanaged, some because of geographic isolation and others because they are unaware they are living with the disease. These companies can identify early-stage patients through their proprietary predictive analytics and treat these patients in various states of disease progression and geographies through multimodal home, virtual, and in-person capabilities.

Patient appeal

A major burden for ESRD patients is the time traveling to and spent in dialysis centers. Kidney platforms reduce this burden through home dialysis and high-touch provider teams that monitor patients’ health and provide care without the patient leaving the home. Customized care plans with various options for treatment empower the patient to take part in their care journey and enhance their experience and quality of life. 

Innovations

These disruptive platforms are challenging traditional models of treating kidney care by accelerating the adoption of home dialysis and securing patient engagement through a digital interface. While these approaches are innovative compared to the status quo, many of the existing kidney platforms have followed a similar formula for managing kidney patients. The model of technology-enabled prevention and home treatment will likely be replicated not only within kidney but with other chronic diseases. 

Top impacted stakeholders

Hospitals and health systems

• Digitally enabled kidney care managers can benefit health systems in value-based arrangements by reducing readmission rates, ED utilization, and inpatient length of stay for ESRD patients.
• New kidney care platforms are poised to disrupt volumes for hospitals and hospital-owned dialysis clinics if the new platforms continue to reduce the number of inpatient dialysis starts and the volume of kidney patients in hospital. To keep up with these trends, hospitals should diversify their service offerings to serve non-ESRD kidney patients.

Health plans

• Working with value-based kidney platforms will likely lower costs and unnecessary utilization. This will help payers gain a better understanding of disease levels in their populations while increasing patient satisfaction.
• Payers face losing out on savings if they cannot properly attribute risk between providers. Because kidney platforms do not take the place of providers, payers must ensure there is enough dollars to go around with risk sharing agreements between platforms and providers.

Physicians and medical groups

• As primary care providers enter risk arrangements, providers must account for their high-spend kidney patients, many of whom don’t yet know they have CKD.
• Primary care should look toward risk-sharing partners, like the kidney care platforms discussed in this report, which can help them understand and manage their high-spend chronic patients to succeed in risk.
• Kidney care platforms in turn are looking to primary care providers as upstream providers for comorbid conditions that impact hospitalization and clinical outcomes, like diabetes and hypertension

Influential player with potential to diversify

Kidney care managers are influential players in many markets today and will continue to expand the number of geographic markets and business lines where they compete across the next five years.

What we’re watching

The pace of growth and future disruptive potential of kidney care management platforms (and other chronic disease platforms) will depend on their ability to:

• Stay relevant despite pharmaceutical innovations by proving patient adherence and engagement gains
• Integrate with providers to demonstrate strong cost savings for payers and avoid siloed care
• Address the barriers to care associated with social determinants of health
• Diversify their platform offerings to include in-person care in addition to home and virtual capabilities
• Innovate their digital platforms to improve user interface, address digital literacy concerns, and achieve patient buy-in
•  Insert themselves as referral options for multiple clinical decision-makers

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