WASHINGTON—A pilot program focused on collaborative care may improve outcomes and reduce costs associated with end-stage renal disease (ESRD), researchers found.

Patients in the Medicare demonstration project met all Quality Incentive Program (QIP) metrics for much of the study, and by the second year of the program had significantly lower costs compared with fee-for-service patients, Allen Nissenson, MD, chief medical officer of DaVita in El Segundo, Calif., and colleagues reported at the National Kidney Foundation (NKF) meeting here.

The program was implemented in several DaVita dialysis centers in southern California, serving about 550 patients, and was conducted from 2008 to 2010. All patients had aggressive preventive care, management of comorbid conditions, and monitoring by a care manager throughout the entire program.

Nissenson said the program focused on integrating healthcare across various aspects of care, not just the dialysis units, and involved teams comprising clinicians, nurse practitioners, case managers, and pharmacists. In addition to medical management, the program also incorporated nutrition education, fluid management, and other components that made it a more holistic approach to care, he said.

DaVita received a single monthly payment per patient "to cover it all," Nissenson said. "It's sort of like the ultimate bundling."

He and his colleagues evaluated outcomes and costs associated with the demo project. They found that patients hit nine out of 11 QIP targets in the first half of 2008, and then hit all 11 targets after that point through 2010.

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