Anthem, Somatus partner on multiyear kidney care collaboration
Services are available to members in Medicare Advantage plans now and in ESKD Chronic Special Needs Plans starting January 1.
Photo: Pramote Polyamate/Getty Images
Anthem is teaming with value-based kidney care company Somatus on a long-term, multiyear partnership that aims to improve kidney care and delivery for members of Anthem's affiliated Medicare Advantage plans, specifically individuals with chronic kidney disease (CKD) Stage 3, 4 and 5 and end-stage kidney disease (ESKD).
Somatus' services are available to eligible CKD and ESKD members enrolled in Anthem-affiliated Medicare Advantage plans as of November 1, and ESKD Chronic Special Needs Plans starting on January 1, 2022. In addition to the partnership, Anthem made a strategic investment in Somatus, the company said.
WHAT'S THE IMPACT?
While the move is the latest by an insurer to improve its offerings, the partnership also stands to benefit Somatus. It expands the company's geographic footprint to 34 states and increases the number of its kidney-care lives under management to more than 150,000.
The company is currently partnered with 10 national and regional health plans, several dozen hospitals and health systems, and more than 19,000 primary care providers, nephrologists and other specialists.
As part of the collaboration, Anthem said it will enable bi-directional data exchange with Somatus via Anthem's Health OS, a cloud native, payer- and provider-agnostic platform for health that connects siloed health data and disparate technologies with the aim of driving deeper insights, as well as reducing costs and complexity.
The bi-directional data exchange will transmit alerts on member admission and discharge to optimize care, simplify coordination with Anthem care management personnel and enhance the consumer and provider experience, the companies said.
The program is "innovative," and the partnership ensures consumers will receive personalized, in-home care and resources, said Elena McFann, president of Anthem's Medicare business, in a statement.
THE LARGER TREND
The Anthem-Somatus partnership is the latest effort by an insurer to strengthen its offerings for those afflicted with kidney disease. In April, Blue Cross and Blue Shield of Minnesota partnered with VillageHealth, an integrated kidney-care program from DaVita, to enable those with permanent kidney failure to enroll in Medicare Advantage plans.
The value-based agreement is designed to improve health outcomes and reduce the total cost of care for eligible Blue Cross members.
Then in August, Cricket Health closed an $83.5 million Series B funding round led by Valtruis, which enabled Cricket's expansion to support demand for its care model for people with kidney disease. Blue Shield of California made a strategic investment of an unspecified amount.
The expansion improves clinical outcomes for people with kidney disease, resulting in lower costs for health plan partners, according to Cricket. In both Texas and California, across commercial and Medicare Advantage health plan partnerships, Cricket Health said it has shown improvements in key clinical measures for its populations living with kidney disease.
Even the federal government has entered the fray, with the Centers for Medicare and Medicaid Services announcing in September 2020 that it had finalized the End-Stage Renal Disease Treatment Choices Model, meant to improve or maintain quality of care and reduce Medicare expenditures for patients with chronic kidney disease.
Roughly 20% of dollars in traditional Medicare – $114 billion a year – are spent on Americans with kidney disease, according to CMS. While more than 100,000 Americans begin dialysis to treat end-stage renal disease each year, one in five will die within a year.
ON THE RECORD
"Through this national partnership with Anthem and support from both local and community-based providers, Somatus' reach and pursuit of our mission has taken a tremendous leap forward," said Dr. Ikenna Okezie, CEO and cofounder of Somatus. "We are grateful to partner alongside Anthem as we, together, continue to improve the lives of so many living with kidney disease."
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
