Pharmacists Can Close CKD Medication Adherence Gaps, PHTI Says

In an interview with Pharmacy Times, Caroline Pearson, executive director of the Peterson Health Technology Institute (PHTI), discussed why virtual chronic kidney disease (CKD) care companies are managing billions of dollars in spending while generating only marginal savings—and what she says pharmacists and health plans should do about it.

Pearson explained that these companies typically accept full total-cost-of-care risk for every patient with CKD within a health plan or region, even though many of those patients are never directly contacted or engaged. As a result, the companies oversee enormous sums: for a million-member Medicare Advantage plan, a virtual CKD vendor might be responsible for roughly $5 billion in annual health care spending but generate savings of under $5 million—about a tenth of a percentage point. Because there’s no evidence these companies are slowing disease progression or reducing hospitalizations, Pearson said, there simply isn’t enough clinical benefit to move the total cost of care across such a large population.

Pearson pointed to medication adherence as the biggest missed opportunity. Effective, affordable, guideline-recommended medications exist, yet only about half of patients with CKD are taking an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, and only 15% are on an sodium-glucose cotransporter 2 inhibitor—even as both drug classes become increasingly generic. She called this the clearest opening for pharmacists: identifying adherence gaps, helping patients start recommended medications, and supporting them through side effects, cost concerns, or other barriers to staying on therapy.

Asked what health plans and employers should demand before investing further, Pearson said evidence should come first—these companies have produced little clinical proof that they improve outcomes. She also urged tying payment to patient-level results, such as medication adherence and optimal dialysis starts, rather than relying solely on total-cost-of-care contracts, and cautioned that some savings reported by these companies may stem from coding and revenue-maximizing practices rather than genuine reductions in cost.