Contributor: Engagement Is the Missing Link in Kidney Care—How Payers and Value-Based Partnerships Can Close the Gap

Chronic kidney disease (CKD) affects about 35.5 million Americans and contributes to more than $120 billion in annual health care costs. Yet despite its scale, CKD often progresses silently among aging health plan members, especially with the growing prevalence of comorbidities such as diabetes and hypertension, emerging as a significant risk that many insurers aren’t fully equipped to manage. Before long, payers can find themselves managing a large, high-cost cohort without the tools or infrastructure to support it effectively.

That’s why kidney care deserves a sharper focus across the insurance landscape, particularly in Medicare Advantage (MA). By getting out in front of this rising challenge through value-based partnerships and proactive patient engagement, payers can not only improve outcomes but also contain costs and strengthen member satisfaction. Engagement remains the missing link that turns these models from policy into real progress.

Why Engagement Matters

CKD is a complex condition. Most patients are managing not just kidney disease but also heart disease, diabetes, or other chronic illnesses. Navigating that web of providers can be overwhelming, and too often patients are left to prioritize which piece of their health to focus on, missing critical opportunities to slow kidney decline.

Multiple studies show engaged patients are more likely to attend nephrology visits, manage comorbidities, adhere to medications, and pursue lifestyle interventions that slow disease progression. For MA plans, higher engagement is correlated with improved star ratings and reduced hospitalizations, which directly impact both quality scores and financial performance.

Moreover, engagement can help narrow persistent inequities. Patients who are empowered and informed are more likely to access early-stage interventions, benefit from care coordination, and pursue transplant evaluation when appropriate. Engagement is not a soft skill; it is a measurable, impactful lever in value-based kidney care.

What Engagement Looks Like

Recognizing the value of engagement is only the first step. The harder, and more rewarding, work lies in making it real for patients. That’s where value-based care (VBC) partnerships can change the equation.

Unlike fee-for-service (FFS) care, where patient contact is often limited to episodic visits, VBC providers focus on holistic, proactive, patient-centered care and improving patients’ overall quality of life. Realizing the benefits of VBC models, payers are increasingly entering into dedicated VBC partnerships that provide the infrastructure, holistic resources, and support needed to engage patients proactively and deliver measurable results.

Engagement begins the moment a patient is enrolled in a VBC program. A care team member with the VBC partner conducts an initial assessment to collect health data and identify ways to build trust and value for the patient. That trust grows when nurses, social workers, dietitians, and other care team members take time to listen and follow through to address patient needs. Small, consistent acts—calling back or checking on a concern even when it isn’t “kidney-related”—signal reliability and respect, turning routine outreach into a real relationship.

Take a patient we’ll call Mindy, a 62-year-old with CKD and several comorbidities. Predictive analytics flagged her as high risk for hospitalization and disease progression, prompting our value-based kidney care team to prioritize reaching out to her. Through routine check-ins, Mindy’s nurse built a connection with her and identified symptoms that required medication adjustments. The nurse connected Mindy with a dietitian when her A1C levels spiked and a coordinator who arranged transportation for a cardiology appointment she would have otherwise missed. Just as important, when Mindy expressed fear after her best friend started dialysis, her nurse provided education and reassurance that she was on the right path to protect her kidneys.

That is engagement: a relationship that grows over time, where patients not only answer calls but begin to share information they might have kept to themselves in a transactional encounter. Building trust establishes a feedback loop: patients respond to outreach and start reaching out on their own when they need help, enabling care teams to intervene earlier and provide better support.

Barriers to Engagement

Despite its benefits, several systemic barriers limit engagement. Trust gaps, particularly among historically marginalized communities, can prevent patients from sharing crucial information or following care recommendations. Social determinants of health, including housing instability, food insecurity, and transportation challenges, affect patients’ ability to participate in their care. Fragmented health systems and limited interoperability reduce opportunities for timely outreach and follow-up.

Framing these obstacles as system challenges rather than patient shortcomings is essential. Patients are often willing but unsupported. By sharing timely data, validating outreach, and aligning resources around patient needs, payers can make it easier for care teams to stay connected and for engagement to take hold.

Partnering with a dedicated value-based kidney care organization gives providers the infrastructure, analytics, and multidisciplinary support they need to sustain that connection, turning good intentions into measurable outcomes. In our internal data from more than 10,000 patients supported through 1 payer partner and their dedicated value-based kidney care provider team, structured patient engagement was associated with:

• A 12% reduction in total cost of care
• A 15% reduction in all-cause hospitalizations

Just as notable, engaging patients in a wraparound care program increased the percentage of patients followed by a nephrologist after 15 months of partnership with 1 health plan by 34%. This matters because early referral to a nephrologist is associated with slower disease progression, fewer hospitalizations, and lower mortality. 

These are not abstract metrics. Behind them are patients like Alice, who entered into a VBC program in 2022 after learning she had late-stage kidney disease. With support from a nurse, dietitian, social worker, and care coordinator, she learned how to change her diet, access food and financial resources, and manage her condition. This structured, team-based approach has helped her maintain kidney function, avoid dialysis, and stay engaged in her overall health.

The Power of Collaboration

The most successful engagement programs are built on deliberate collaboration between payers and value-based kidney care partners with shared accountability for engagement outcomes.

Leveraging interdisciplinary care team members, data-driven metrics, and advanced technology, value-based care providers enable personalized, coordinated care and data sharing across the care continuum. For instance, proprietary, artificial intelligence–driven predictive models can analyze multiple data sources to identify patients at risk of hospitalization or CKD progression early, enabling timely interventions that build long-term, trusting relationships and improve outcomes.

Payers also play a role in ensuring patient engagement programs are successful. Here are a few ways payers can directly strengthen engagement:

• Introduce and validate care partners: Patients are more likely to respond when introductions come from their health plan or when materials are co-branded, signaling legitimacy and trust.
• Share timely data: Claims and hospitalization data allow care teams to predict risk and prioritize outreach to anticipate patient needs and intervene before emergencies occur.
• Align case management teams: Coordination between payer case managers and care teams ensures consistent, trusted messaging rather than fragmented outreach.
• Support multi-modal outreach: Phone, mail, text, and digital channels allow communication with patients according to their preferences and capabilities.

For payers, the case for patient engagement in CKD is compelling. It improves outcomes, reduces costs, supports quality metrics and star ratings, and strengthens member satisfaction. But it doesn’t happen on its own. It requires deliberate partnership, shared data, and validation of trusted care teams.

Engagement thrives when payers, providers, and care partners work as one. By leaning in as true collaborators who share insights, reinforce trust, and align on patient goals, payers can make engagement sustainable and scalable across populations.