Matthew Collins, M.D., M.B.A. is BCBSRI’s executive vice president and chief medical officer, with comprehensive oversight for our medical management, care management, utilization management, and behavioral health management areas. Matt’s goals are ensuring our members get the right care at the right time in the right setting, while leading our efforts to control the increase of total medical expenses. He also brings a unique perspective to his role with a background as a family physician.

Kidney disease is widely recognized as a global public health issue, one that is considered a risk multiplier for many other health conditions such as hypertension/cardiovascular disease, diabetes, and infections. Typically, chronic kidney disease (CKD) progresses to end-stage renal disease (ESRD), and once that stage is reached, the last resort is kidney replacement therapy (dialysis or kidney transplantation). It’s a dire scenario that is all too common, not to mention the significant impact on healthcare costs. Early detection and intervention are critically important.

BCBSRI’s Chronic Kidney Disease program aims to detect CKD early and delay or hopefully avoid progression to later stages. Partnering with Brown Medicine Nephrology and local nephrology groups/practices, we created this care management program that is offered to more than 800 of our commercial and Medicare Advantage members who have both CKD (stage 4 or 5) and ESRD. The program has two phases: one focuses on keeping members from going into hemodialysis (or “crashing”), and the second is centered on delaying the progression of CKD by carefully planning for next steps with patients, which can mean planned outpatient dialysis, transplantation, or sometimes palliative care. The goal is to help patients with ESRD manage their condition and help them avoid hospitalization.

Another goal is to promote early detection of CKD in the primary care setting, along with timely diagnoses and referrals to nephrology specialists/centers. Nephrology groups are incented for every BCBSRI member who begins dialysis on an outpatient basis, and Brown Medicine Nephrology has received funding to support creation of a cohesive nephrology care model that assigns members diagnosed with CKD and ESRD to a care team with a nurse care manager, pharmacist support, health educators, and other aligned medical professionals.

That team provides guidance, support, and clinical coordination to assist members navigating the disease and their treatment options. This inter-disciplinary approach is akin to the type of care typical for other diseases and conditions, such as cancer. For CKD, it’s vital to incorporate specialist teams into patient care early to monitor common causes (hypertension, diabetes) in an effort to slow the progression of the disease and avoid the imminent problem – patients crashing into hemodialysis.

Another important consideration is that not all patients are suitable candidates for or will benefit from dialysis. For some, transplantation gives patients a better chance at survival and an improved quality of life and may be more cost-effective than dialysis. Or maybe in-home dialysis is a better option than at a facility. It’s important to weigh a variety of factors, such as the patient’s age and functional status, to determine the best course of action.

Early results from the Brown Medicine program have been positive. From 2021 until March 2022 we have observed a decrease in crash rates among participating members, an increase in outpatient planned dialysis starts, and a slight reduction in inpatient hospital admissions. We’re optimistic that we’ll continue seeing positive results from our CKD program, and we’re thankful for the partnerships we have in place to achieve the program’s goals.

There are several medical observances in October, including Breast Cancer Awareness Month and National Primary Care Week, from October 2-8. As always, thank you for your partnership and all you do to help our members stay safe and healthy.