Virtual CKD Programs Show Limited Impact on Disease Progression and Costs, Analysis Finds

Virtual programs for managing chronic kidney disease (CKD) have not been shown to slow disease progression or lower overall healthcare spending, according to a new analysis from the Peterson Health Technology Institute (PHTI).

PHTI, an independent evaluator of digital health solutions, reviewed more than 5,400 articles and other sources of evidence. The report examined DaVita IKC, Evergreen Nephrology, Healthmap Solutions, Interwell Health, Kidneylink, Monogram Health, Somatus and Strive Health. These companies assume financial responsibility for the total cost of care for patients with stage 3–5 CKD and typically partner with Medicare Advantage plans and Medicare’s Kidney Care Choices model.

The assessment focused on interventions intended to manage CKD before it advances to end-stage kidney disease, when patients require dialysis or a kidney transplant.

PHTI found no consistent evidence that virtual CKD management programs slow disease progression compared with standard care. The programs have not reliably increased use of recommended medications or reduced the rate of kidney-function decline.

The analysis also found no meaningful reduction in healthcare spending. For a Medicare Advantage plan with 1 million members, these CKD companies oversee more than $5 billion in annual healthcare spending while producing cost savings of only 0.1%.

The programs did help a small number of patients transition more effectively to dialysis. Virtual management may make it more likely that patients begin dialysis in a planned outpatient setting rather than through an emergency “crash” start, which can cause complications and higher costs. However, PHTI estimated that this benefit applies to only about one in 1,000 patients with CKD.

According to the report, the greatest opportunity to improve CKD outcomes lies earlier in the disease. Current programs generally focus on patients with more advanced CKD. PHTI recommends that healthcare purchasers revise contracts and incentive programs to reward milestones associated with slower disease progression, including earlier diagnosis.

The organization also recommends greater engagement with primary care providers and stronger evidence-gathering to identify which CKD interventions are most effective.

“CKD is a common and undertreated condition affecting millions of Americans. The good news is that we know how to manage this disease effectively through early diagnosis and medications,” said Caroline Pearson, PHTI’s executive director. “But instead of investing in what works, population-level CKD payment models have created mismatched incentives that drive a focus on cost control for patients with diagnosed, later-stage CKD. Contracts for virtual CKD solutions should pay for the outcomes that actually slow disease progression—earlier diagnosis and better medication management—at an individual patient level.”

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