An evaluation by the Peterson Health Technology Institute (PHTI) found no consistent evidence that virtual chronic kidney disease (CKD) management solutions slow disease progression or reduce overall healthcare spending across the population of covered patients. The report recommends that health plans and CMS should prioritize earlier diagnosis and focus on getting patients on the right medications—many of which it says are proven, generic, and under-prescribed.

The report notes that these companies assume financial responsibility for the total cost of care of patients with diagnosed CKD stages 3–5, typically including every eligible patient in a geography or affiliated with a participating nephrology practice, regardless of whether the company has any direct interaction with the patient. They all contract with Medicare Advantage plans and most participate in Medicare's Kidney Care Choices (KCC) model.

The evaluation has two primary components: clinical effectiveness and economic impact. Findings are based on evidence from a systematic literature review, company-submitted information, company website reviews, and data from the Centers for Medicare & Medicaid Services’ KCC model

Clinical Effectiveness: PHTI’s review of the evidence found that these virtual solutions for CKD management show no consistent evidence of slowing disease progression — either by improving medication use or by slowing the rate of kidney function decline — compared with usual care. They demonstrate some benefit in improving the rate of planned dialysis starts, the report says, but these benefits do not translate to meaningful reductions in hospitalizations or other healthcare utilization. “Moreover, improvements in optimal starts do not generate meaningful clinical impact or savings at the population level, because only 1 in 100 attributed patients begin dialysis annually and only 1 in 1,000 patients would experience an improved start.”

Economic Impact: PHTI’s budget impact model finds small reductions in healthcare spending driven by improvements in planned dialysis transitions, which it calls “immaterial when spread across the full attributed CKD population. Nonetheless, health plans may continue to value these solutions because they may improve risk coding, lower medical loss ratios, and increase budget predictability, all of which create value for the plan and company—even absent cost of care reductions—within current contracting structures.”

The report notes that the Kidney Care Choices Model — launched in 2022 as a large-scale demonstration, has found no reductions in healthcare spending for patients with CKD who were covered in the model compared with those who were not, and incentive payments to participating nephrology practices added to overall Medicare spending.

In the report’s introduction, Caroline Peterson, PHTI’s executive director, stated that the challenge is that payment models focus too much on late-stage CKD. “The better opportunity to drive change is upstream: by increasing early screening and diagnosis and by focusing on medication management, most patients could avoid progressing to end-stage kidney disease altogether,” she wrote. “Yet because these companies are responsible only for diagnosed patients and work primarily with nephrologists, they have neither the incentive nor the access to improve CKD diagnosis in primary care settings. And because many patients go undiagnosed until the disease is advanced, these companies have limited opportunity to slow disease progression. The best they can do for most patients is help them avoid crashing into dialysis. That is a real improvement, but one that helps too few patients to meaningfully reduce system spending.”

Peterson said the findings suggest that health plans and CMS should prioritize earlier diagnosis and focus on getting patients on the right medications. “We have the clinical tools available. Now we need contracting and payment models that reward early detection, rather than late-stage interventions. With the right incentives, it is possible to close this gap between guideline-recommended care and what patients actually receive.”