Payer Strategies for Earlier CKD Screening and Identification

"Payer Strategies for Earlier CKD Screening and Identification" takes up the question of how payers can find chronic kidney disease earlier and act on it.

Dr. Haumschild frames this episode around moving payers from utilization managers to population health partners. He says payers must keep evolving to meet members where they actually are. The first step toward earlier CKD identification already has a useful framework in place. The HEDIS kidney health evaluation measure checks both EGFR and UACR in diabetic adults. Many plans already use this measure when making coverage determinations for their populations. But Dr. Haumschild cautions that checking the box on a lab value is not enough. The real question becomes what happens next once that result comes back. A member-centric population health approach can flag a patient with albuminuria or declining EGFR. From there, plans can determine whether that patient is receiving appropriate RAS blockade therapy. They can also check whether the patient is on an SGLT2 inhibitor or other guideline-directed treatment. Once a gap is identified, it needs to become an actionable alert for providers. Dr. Haumschild prefers alerts placed directly in the clinical workflow over retrospective reports. Retrospective reports, he notes, are easy for busy clinicians to overlook or deprioritize. Payers can also review claims data to identify the best moments to engage members directly. He would ultimately like to see the quality measure itself evolve going forward. Today's measure often just asks whether a patient was screened for CKD at all. Tomorrow's measure should ask whether that screening led to appropriate kidney-protective therapy being started. That shift, he says, is where population health measurement needs to head next. It moves the focus from process compliance to whether interventions actually changed outcomes for patients. That distinction, in his view, is what makes a quality measure genuinely meaningful for care.

In "GLP-1 vs SGLT2 Inhibitors: Balancing Evidence and Care Continuity," the discussion widens to how SGLT2 inhibitors and GLP-1s should - and shouldn't - be weighed against each other.