IRVING, Texas, Aug. 29, 2023 – Vizient, Inc. announced the publication of its first public report on care utilization and quality using data from Medicare's Data Sharing for Performance Measurement, also known as the Qualified Entity Program (QEP). The report, "Measuring Care Utilization and Quality for Those with Chronic Kidney Disease by Payer and Community Vulnerability," evaluates the cost and quality of care provided to patients with chronic kidney disease (CKD) and end stage renal disease (ESRD) by payer, based on four indicators of resource use and quality and also explores outcomes through the lens of high social need communities using the patent pending Vizient Vulnerability IndexTM.
Vizient selected CKD and ESRD for its research as both are high-cost conditions but can be managed, and even potentially prevented, if diagnosed early in the progression of disease. Epidemiologic trends in the U.S. shows a rise in rates of diabetes and hypertension, the two leading causes of CKD and ESRD, creating the need for more attention to screening for earlier diagnosis.
Additionally, there is a growing body of clinical literature on differences in treatment outcomes when social determinants of health are factored in. This study shows that CKD prevalence and outcomes are worse for patients living in communities with more unmet social needs, highlighting a disparity that has likely been impacted by the use of racially based thresholds for CKD diagnosis, impacting historically marginalized populations.
"Chronic kidney disease (CKD) affects more than 35 million adults, and the CDC reports as many as 9 out of 10 people with CKD do not even know they have it. If not carefully managed, CKD can progress to end stage renal disease requiring regular dialysis," said Dr. Madeleine McDowell, sr. principal, Advanced Analytics and Informatics, Vizient. "By analyzing prevalence rates of CKD and ESRD and health equity data, we were able to identify stark differences in high social need communities both in overall rates of disease and in severity of disease. Most importantly, we found communities with the lowest rates of screening had the highest rates of dialysis underscoring the importance of early and regular screening in high social need communities."
For its analysis, Vizient has combined Medicare FFS claims data received from CMS as part of the Qualified Entity (QE) program with a proprietary All-Payer Claims set from Sg2, a Vizient company, that contains data for Medicare Advantage, Commercial and Medicaid payers to provide comprehensive insights that can drive improvement and advance health equity. The Vizient Vulnerability Index was utilized to identify community-level variation in outcomes related to CKD.
Key findings from the report include:
- As patients progress through the stages of CKD, the cost of their care increases dramatically, with significantly greater utilization of inpatient care as seen through higher hospitalization rates and unplanned readmission rates for those with CKD.
- The burden of CKD disproportionately affects the most socially challenged neighborhoods. The most socially challenged neighborhoods had a CKD prevalence that was 40% higher than the least socially challenged neighborhoods in 2021.
- Outcomes related to CKD are worse for those living in the most socially challenged areas. The prevalence of patients on dialysis is seven times higher compared to the least socially challenged neighborhoods and the average age of a person on dialysis is nine years younger.
- Within the same city, the prevalence of dialysis is 3 to 21 times higher in the neighborhoods with the most social needs compared with neighborhoods with the least social needs within the same city.
- Communities with low levels of kidney health screenings also had the highest rates of dialysis. In neighborhoods with a high prevalence of CKD, there were 5.1 dialysis patients per 1,000 beneficiaries in low screening communities compared to 2.9 in high screening communities.
"Providers are looking for data and analytic insights that span the care continuum to better understand how to manage patients with CKD and the cost of care. With early screenings and the use of new medical interventions, providers may be able to slow progression and prevent ESRD," said McDowell. "Early screenings for patients living in communities with high rates of metabolic disease, can minimize the number of patients requiring dialysis, reduce inpatient stays and ED visits, and improve the quality of life of the patients. Information from this study can also lead to further analysis in use of medications that can improve patient outcomes."
The CMS Qualified Entity Program enables certified organizations to receive Medicare claims data under Parts A, B, and D for use in evaluating provider performance. Only 40 organizations are QEs and of those, only 22, including Vizient, have access to nationwide data. Access Vizient’s CMS Qualified Entity Public Report.
About Vizient, Inc.
Vizient, Inc., the nation’s largest member-driven healthcare performance improvement company, serves more than 60% of the nation’s acute care providers, which includes 97% of the nation’s academic medical centers, and more than 25% of the non-acute care market. Vizient provides expertise, analytics and advisory services, as well as a contract portfolio that represents more than $130 billion in annual purchasing volume. Vizient’s solutions and services improve the delivery of high-value care by aligning cost, quality and market performance. Headquartered in Irving, Texas, Vizient has offices throughout the United States. Learn more at www.vizientinc.com.