Serving the Kidney Care Population
Better Outcomes
Start With a
Better Care Model
A Better Plan
for ESRD &
CKD Patients
We created Champion Health Plans USA, LLC, to address the significant treatment issues for individuals with ESRD and Late-Stage Chronic Kidney Disease (CKD). Our model of care helps improve care for these individuals by addressing health equity issues and social determinants facing this population.
Champion Health Plan is a Medicare Advantage Prescription Drug HMO Chronic – Special Needs Plan (CSNP) for Medicare Beneficiaries with end stage renal disease (ESRD). Champion Health Plan will begin operation in 7 California counties and 4 Nevada counties on 1/1/2024.
Champion Payer Solutions, LLC was established as a plan-agnostic managed care managed service organization (MSO) to support complex populations and community services.
The goal of Champion Health Plans USA, LLC is
to be the solution for improved care.
Solving the Problem of Expensive, Inefficient ESRD Care
The Problem
- Treatment is expensive, demanding and complex
- Incentives are misaligned
Patients with advanced kidney disease often have many co-morbidities (e.g. diabetes, congestive heart failure, obesity)
In addition to a multitude of serious medical conditions, many patients face inadequate home support, insufficient cash for medical co-pays, challenges accessing safe housing and lack of nutritious food and transportation to needed care
Existing fee-for-service-based Medicare reimbursement models curtail nephrologists’ ability to tailor patient care programs to address complex underlying social determinants of health
These medical and social determinants of health, and health equity issues, result in a higher cost to the system and lead to fragmented care
The Solution
- A Medicare Advantage Prescription Drug Special Needs Plan (MAPD-SNP) for ESRD Patients
Economic Alignment with Nephrologists
Improved Health Outcomes
Lower Overall Cost of Care
Dialysis Extends Lives, but it is Complicated to Maintain and Costly
ESRD is life-threatening and irreversible
Patients have two options for survival: dialysis or kidney transplant
Impact of Missed Dialysis
Increased likelihood of hospitalization after 1 missed dialysis visit(1)
Avoidable
Costs
>$20,000
Estimated cost to a MAPD plan for each hospitalization(3)
Dialysis treatment requires careful adherence to often complicated treatments
Increase in chance of hospitalization (within a month) after more than 2 missed visits(1)
1.75 per year
Number of times a dialysis patient is hospitalized each year
Non-adherence inevitably leads to hospitalization, adverse health effects and death
Increased risk of death in the week following a single missed treatment(2)
$10,000
Annual cost savings per patient from lower hospitalization rates attributable to Champion Health Plan’s incentive-aligned model(4)
(1) Anderson, Amanda H et al. “Missed dialysis sessions and hospitalization in hemodialysis patients after Hurricane Katrina.” Kidney international vol. 75,11 (2009): 1202-1208.
(2) Obialo, Chamberlain I et al. “Relationship of missed and shortened hemodialysis treatments to hospitalization and mortality: observations from a US dialysis network.” Clinical kidney journal vol. 5,4 (2012): 315-9.
(3) Includes the cost of the hospital’s DRG-based fee, emergency room and hospital physicians and emergency ambulance transfers.
(4) Assumes success of Champion Health Plans USA, LLC’s one-year operating goal of lowering average annual hospitalization rate of dialysis patients to 1.25. Source: Centers for Medicare & Medicaid Services (CMS).
The Champion Health Plan Model of Care is Centered Around the Doctor Who Sees the Patient the Most: the Nephrologist
(1) Based on the estimation that each nephrologist may be responsible for ~$7mm in healthcare expenditures, or $120,000 reimbursement per patient with 60 patients under their care.
Specialized,
Tech-Enabled
Support
Programs
Our programs improve the success of Home Dialysis with feet-on-the-ground case management and special benefits designed specifically to support individuals with ESRD. Our teams are empowered by AI analytics and data reporting, care triggers, guidance for polypharmacy issues and multiple forms of telehealth support.
An
Innovative
Approach
Our unique care model includes rewarding contracted nephrologists, dialysis centers and other key care providers by working with the plan to improve patients’ overall quality of life while providing our value-based providers the opportunity to improve their overall income as they keep patients healthy.
Fee-for-service programs have their limitations
Patients win with better health and fewer hospitalizations.
Dialysis centers win with optimized treatment and in-home options.
Nephrologists win with a cost-sharing reward model.
Our health plan wins by increasing patient compliance, which reduces hospitalization.