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Medicare Advantage Plans and the Cures Act:
Bending the ESRD Trend

  • November 06, 2020
  • 1:00 PM – 2:00 PM ET
  • Online
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The 21st Century Cures Act opens the door for previously ineligible end-stage renal disease (ESRD) patients to enroll in a Medicare Advantage (MA) plan.

According to the U.S. Renal Data Systems 2019 Annual Report, there are 746,557 people living with ESRD, a number which climbs by approximately 20,000 each year. CMS projects a 63% increase in the number of people with ESRD who will choose to enroll in a MA plan by 2026.

ESRD is complex to treat and costly to cover. Patients living with ESRD often have co-morbid conditions such as diabetes, hypertension and heart failure. Patients require multidisciplinary care coordination, an extensive medication regimen, and dialysis or a kidney transplant to survive. The cost to care for a patient living with ESRD ranges between $80,000 to $100,000 per patient, per plan year.

This is just the tip of the iceberg. There are 37 million people in the U.S. living with chronic kidney disease, and 90% are unaware of their condition until it reaches the most serious disease state, ESRD. Many are diagnosed when renal failure drives them to an emergency room and they “crash” into dialysis. Overwhelmed and unaware of their options, the vast majority begin dialysis treatment in a dialysis center even though in-home dialysis is as effective, safe and 15% less expensive per patient, per year.

The risk to Medicare Advantage plans is real. The number of patients living with end-stage renal disease (ESRD) continues to grow annually, as does the cost of care, which reached $36 billion in 2017, up $1 billion from the prior year. By participating in this webinar, health insurance provider leaders will learn how to “bend the trend” by improving care, outcomes, member experience and costs.

Attendees will learn:

  • About the risks facing Medicare Advantage plans starting this fall based on historical trends
  • How leveraging big data, artificial intelligence, machine learning and predictive analytics, along with clinical expertise and patient-centered complex care management, can improve care, outcomes, member experience and lower costs
  • Three strategies to “bend the trend”: Early detection, in-home dialysis, and provider-patient engagement & support

Speakers


Joe Vattamattam
President & Chief Financial Officer
Healthmap Solutions

Joe Vattamattam is the President and Chief Financial Officer for Healthmap Solutions. He is responsible for leading the organization to align the company’s innovative product offerings with its value proposition, culminating in high-performing risk-bearing products. As a co-founder of Healthmap, he set the strategic vision in place, leading its growth from an early-stage company to a national market leader in kidney health management.

Joe has broad and deep experience developing, underwriting, pricing, and managing value-creating healthcare programs across multiple niches within healthcare. Joe was critical to driving organic growth, product development, acquisitions, and business process improvement during his tenure as Vice President Medical Economics at CareCentrix, and as Director, Health Services at WellCare Health Plans.

Joe serves as a director on the board of Heritage Property and Casualty Insurance (NYSE: HRTG). He earned his undergraduate degree in mathematics from the University of Florida and his master’s in business administration from Georgetown University.


Elizabeth Prence
Chief Clinical Officer
Healthmap Solutions

As Chief Clinical Quality Officer, Liz is responsible for the clinical validity of Healthmap’s products and guides Healthmap’s Scientific Advisory Board in the development of clinical algorithms, such as those applicable to the identification and treatment of chronically ill patients. Additionally, Liz applies her expertise in the areas of laboratory medicine, medical coding, translation of professional guidelines to practical implementation, quality assurance, and HIPAA compliance.

She is board-certified in both genetics and clinical chemistry, is a fellow of the American College of Medical Genetics and Genomics, and her experience spans commercial, academic and non-profit settings. Her commercial experience includes more than 11 years at Quest Diagnostics, and her academic experience includes faculty appointments at Harvard Medical School, Massachusetts General Hospital, Brandeis University and the University of Pittsburgh Graduate School of Public Health.


Amy Kozsuch
Vice President of Clinical Products
Healthmap Solutions

As Vice President of Clinical Products, Amy is responsible for expanding and developing innovative programs that advance early detection of chronic kidney disease, defer its progression, and deliver improved patient outcomes at lower costs. She has more than 20 years of experience leading clinical teams, health care executives, and physician practices to drive positive change in care delivery systems and overall health care markets.

Amy is the President of the National Kidney Foundation of Florida, past President of the Florida Renal Association and Board Member of the Families with SCN2A Foundation, an organization created by parents of children diagnosed with rare forms of epilepsy and autism. She is a former DaVita executive in the areas of business development and kidney care. Amy earned her MSN, MBA, and HCA from University of Phoenix, where she is currently a doctoral candidate.

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