Advancing American Kidney Health
As part of the Administration’s focus on improving person-centered care, the U.S. Department of Health and Human Services (HHS) is advancing kidney health to revolutionize the way patients with chronic kidney disease and kidney failure are diagnosed, treated, and most importantly, live. The initiatives discussed in this paper are designed to tackle the challenges people living with kidney disease face throughout the stages of kidney disease, while also improving the lives of patients, their caregivers, and family members. The overall goals of these efforts are to: reduce the risk of kidney failure; improve access to and quality of person-centered treatment options; and increase access to kidney transplants.
The Special Diabetes Program for Indians: Estimates of Medicare Savings
Between 1996 and 2013, there was a 54% decrease in the incidence of diabetes-related end-stage renal disease (ESRD-DM) in American Indian and Alaska Native (AI/ AN) populations. This decline has occurred since the Special Diabetes Program for Indians (SDPI) was established in 1997. We estimate that the decrease in ESRD-DM incidence resulted in 2,200 to 2,600 fewer cases and $436 to $520 million of savings to Medicare over a ten-year period, depending on assumptions of what the incidence rate would have been in the absence of diabetic care improvements. Additional savings from the program may accrue to the Indian Health Service and other payers by preventing diabetes and other complications of diabetes such as retinopathy or hospitalizations. Although it is not possible to determine with certainty how much of the decline in ESRD-DM is attributable to SDPI, nothing else has impacted diabetes resources across Indian health care systems as much as SDPI over the past 20 years and improvements in related outcomes in the Al/AN population far surpass those observed in other races.
Assessing the Costs and Benefits of Extending Coverage of Immunosuppressive Drugs under Medicare
By statute, the majority of patients with end-stage renal disease (ESRD) are eligible for Medicare, regardless of age. Kidney transplantation is ultimately considered the best treatment for ESRD, but ESRD-related eligibility for Medicare coverage extends for only 36 months post-transplant. Given the costs to Medicare associated with patients who stop taking immunosuppressive drugs due to cost and revert to developing ESRD, requiring subsequent dialysis and/or kidney transplantation, ASPE analyzed the financial implications of extending Medicare coverage of only immunosuppressive drugs for the lifetime of the patient. We estimate that extending Medicare coverage of immunosuppressive drugs beyond three years post-transplant would result in ten-year accumulated savings of approximately $73 million.