Innovations in Dialysis: Expediting Advances Symposium
Innovations in Dialysis: Expediting Advances Symposium
August 21, 2019
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CVS Kidney Care model uses nurse practitioners to track patients, takes ‘home first’ approach

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Bruce Culleton

SEATTLE — A new care model underway by pharmacy company CVS and health care insurer Aetna is using nurse practitioners stationed at pharmacies across the country to identify and manage patients with chronic kidney disease.

Intervention with social workers, dietitians and other support staff would still occur under the direction of a nephrologist, Bruce Culleton, MD, vice president and chief medical officer for CVS Kidney Care, said. He offered details on the program at the Innovations in Dialysis: Expediting Advances Symposium here.

“The goal is not to have nurses replace nephrologists ... we want the nephrologist to work with patients to identify their comorbidities, talk about what is important to their care [and] help them connect with social workers and dietitians,” he said.

CVS launched the new care model last April in six geographic markets, working with 11 health plans and about 4,700 patients with CKD 4 through 5, Culleton said.

The program is also tied to development of a new home hemodialysis (HHD) machine called the Hemacare. The first patient in the anticipated 2-year clinical trial is expected to begin treatment at home this week.

Home First

Culleton emphasized that the CVS Kidney Care model sees home dialysis as the primary therapy.

“Our approach is home first,” he told attendees. “We are not opening up dialysis clinics ... our plan is to stay as asset-light as possible."

In focusing on home dialysis as the primarily modality option, Culleton acknowledged the problem with the dropout rate in the first 3 months of home dialysis, particularly with HHD. He said it “It is a vulnerable time” for patients starting dialysis, and often leads to high hospitalization rates as well. “We know the dropout rate is significant,” he said. “We know that if we want to expand home dialysis, whether it is HHD or PD, we need to solve that problem.”

“There is also a fear of isolation by going home,” Culleton noted. “One solution is transitional support at home using telehealth. We want patients to feel more connected with the community.”

CVS has developed a support system called HealthHUB: centers set up to deliver community education, provide classes on good health and address patient care needs, such as audiology and optometry care.

“It is a place for patients to learn more about their health,” Culleton said. After a successful pilot project in Houston, CVS is making plans to open 1,500 Health HealthHUBs across the country.

Culleton said CVS supports the recently announced HHS initiative to send more patients home for dialysis care. “We believe we are very much aligned with the program and the objectives in the Advancing American Kidney Health initiative ... the devil is in the details, but we think this is the right direction forward to ensure patients will have more options,” he said. – by Mark E. Neumann

Disclosure: Culleton reports no relevant financial disclosures.