Chronic Kidney Disease: A Major Hurdle for Self-Insured Employers

Many Americans worry that they or their loved ones will suffer from cancer, stroke, heart disease or dementia. Kidney disease isn’t as high-profile a condition, and the average person probably doesn’t give it much thought.

Self-insured employers don’t have that luxury. Chronic kidney disease is common, deadly and hugely expensive to treat.

First, some numbers. One in seven Americans has chronic kidney disease (CKD), estimates the CDC. That accounts for about 30 million people. One in three adults is at risk of developing kidney disease.

A staggering 96% of Americans who have early-stage CKD aren’t aware of it. Kidney disease can progress to end-stage renal disease (ESRD), at which point the patient requires either dialysis or an organ transplant to survive. As of 2014, when the most recent data was gathered, more than 660,000 Americans were living with ESRD. Of those, 468,000 were dialysis patients.

For self-insured employers, these numbers should be sobering. CKD affects adults of all ages. Many people have the disease without knowing it, and failing to get treatment speeds up the progression of ESRD. Once a patient reaches that stage, the only treatment options are extremely expensive. A patient with ESRD may require regular, lifelong dialysis, which often costs between $70,000 and $90,000 per year.  In some parts of the country, these costs can be even higher.

The bottom line: kidney disease is one of the most common medical conditions, and one of the most expensive. Those costs are ongoing, which may be crippling for a self-insured employer. So what’s an employer to do?

Reducing dialysis costs is critical. Embracing home dialysis is one effective way to do that. A session of at-home dialysis costs a fraction of what the same treatment would cost in a dedicated facility, and it allows the patient to get treatment in the comfort and privacy of his own home. It’s in everyone’s best interest for self-insured employers to make this option available and known to its employees.

Drug prices also contribute to skyrocketing costs related to kidney disease. From the blood-pressure medications that can prevent CKD in high-risk people to the anemia drugs that many ESRD patients require, self-insured employers can anticipate that plan members with kidney issues will rack up prescription costs in the thousands of dollars each year. Negotiating drug costs via a dedicated pharmacy benefit manager is one way to manage prescription spending.

Prevention and early diagnosis is also an important piece of the cost-management puzzle. Because CKD generally starts with no symptoms, getting a blood or urine test as part of an annual checkup is the best way to catch the disease early on. Choosing the right plan and creating policies that make it easy and affordable for members to get preventative medical treatment may cost the employer upfront, but could mean big savings down the line.

Self-insured employers have to consider a huge range of factors when making decisions about health benefits, and we know that it can be daunting. Contact us with any questions!