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Digital health tools for chronic kidney care ineffective: PHTI report
Digital chronic kidney disease tools are falling short on their goals of improving patient outcomes and reducing costs, adding to the mixed results of digital health technology.
Another category of digital health devices is not living up to their purported promises.
According to a new Peterson Health Technology Institute report, digital health devices for chronic kidney disease do not slow disease progression nor do they reduce healthcare spending. The finding is significant given that 35.5 million Americans -- that is, one in seven adults -- have CKD.
Virtual CKD management solutions, typically part of risk-based arrangements with Medicare Advantage and commercial health plans, aim to slow the progression of CKD to end-stage kidney disease, a condition that is extremely costly to manage. However, it appears that they are not currently achieving this goal.
For the evaluation, PHTI assessed eight virtual CKD solutions: DaVita Integrated Kidney Care, Evergreen Nephrology, Healthmap Solutions, Interwell Health, Kidneylink, Monogram Health, Somatus and Strive Health. These companies take on the total cost of care for patients diagnosed with stages three to five of CKD. Most also participate in CMS' Kidney Care Choices Model.
Researchers examined more than 5,400 articles, as well as information submitted by the companies and performance and financial data from the KCC model.
What the evaluation found
Compared with usual care, virtual solutions for CKD management do not show evidence of slowing disease progression. In other words, they neither improvde medication use nor slowed the decline of kidney function, the report shows.
While the solutions did help improve the rate of starting planned dialysis, they did not lead to meaningful reductions in hospitalizations or other healthcare utilization. Further, the solutions were associated with small reductions in healthcare spending, but the researchers observed that these were "immaterial" across the full CKD population. For example, a digital CKD company might be on the hook for $5.4 billion in healthcare spending for a hypothetical Medicare Advantage plan covering 1 million people, but it would reduce that spending by only 0.1%.
The evidence also did not show meaningful differences in the performance of digital health tools across companies.
"CKD is a common and undertreated condition affecting millions of Americans. The good news is that we know how to manage this disease effectively through early diagnosis and medications," said Caroline Pearson, executive director of PHTI, in the press release. "But instead of investing in what works, population-level CKD payment models have created mismatched incentives that drive a focus on cost control for patients with diagnosed, later-stage CKD."
The report further suggested that digital CKD care contracts and incentive programs reward individual-level milestones that are more likely to slow disease progression and that companies actively engage with primary care providers.
Efficacy of digital health devices is mixed
This is not the first time digital health devices have fallen short of their expected impact.
In a March 2024 report, PHTI stated that popular digital tools targeting type 2 diabetes do not provide meaningful clinical benefits. The report showed that any improvements in glycemic control associated with the tools were minimal and short-term. Those small improvements were not sustained over time.
Not only that, but the researchers found that tools increased total health spending over a one-to three-year period.
Similarly, another PHTI report showed that virtual solutions to manage opioid use disorder were no better than traditional medication-based treatment. They did not increase participation in OUD programs, nor did they reduce spending compared with usual care.
However, other digital health tools have fared better. A PHTI evaluation released earlier this year revealed that virtual gastrointestinal solutions improved clinical outcomes and helped reduce total healthcare spending.
Not only that, but digital hypertension management solutions that coordinate medication adjustments virtually are generally effective, PHTI found.
These evaluations are critical as the digital health industry matures and healthcare providers and payers emphasize value over volume in their digital health investments.
Anuja Vaidya has covered the healthcare industry since 2012. She currently covers healthcare IT and innovation, including artificial intelligence, digital healthcare, EHRs and interoperability.
