Renal Failure: Avoiding the Point of No Return is Key
John didn’t know it, but his health was sliding dangerously close to the edge of a cliff. Once over the edge, there would be no going back. It was a point of no return, and a life of permanent sickness, high expense and dependency.
Fortunately for John (which, for privacy protection, is not his real name), his health condition was still reversible; he could improve his poor health. And he had recently become a participant in his employer’s healthcare management program through Curally.
When he showed up on Curally’s radar, John’s serious health problems were not apparent to him. Yet he had hypertension, and it was out of control.
One of John’s problems was he had not seen his physician in more than a year. His health status was unmonitored, allowing it to deteriorate.
John’s crisis situation was discovered by Curally’s Chief Medical Officer, Dr. Ernie Vesta, who routinely reviews the medical claims of clients, looking for patterns indicating a problem.
Dr. Vesta identified the warning signs in John’s claims history and followed up by asking for a visit. It was in the visit with John that his state of sickness came more fully into view. Dr. Vesta concluded John’s condition needed prompt attention. Follow-up tests through John’s physician confirmed it: John was perilously close to falling over the edge of the cliff, stage 5 renal failure, from which there was no return.
Renal Failure’s Consequences: Poor Health, High Expense, Loss of Independence
In stage 5 renal failure, also known as end stage renal disease, the kidneys no longer function their vital roles in balancing fluids in the body and filtering out impurities. At that point, the patient requires dialysis every two to three days, hooked up to machines for hours at a time. The machines serve in place of the kidneys, filtering and eliminating harmful waste and fluids from the blood. The patient is also prescribed medication which, unfortunately, is neither comfortable nor inexpensive.
According to a review of medical claims data, the cost of dialysis can eclipse $200,000 per year per individual.
Some stage 5 renal failure patients will qualify for a kidney transplant, which can improve the patient’s quality of life, but it is not a cure, and it is not without complications. Today, according to the nonprofit American Kidney Fund, nearly 100,000 patients are on a waiting list for kidney transplant, more than for all other organ transplants combined.
The cost of a kidney transplant can run roughly $250,000, plus an additional $10,000 – $15,000 per year in immunosuppressant drugs to support the transplant, according to data reviewed by Curally. Transplanted kidneys are expected to be effective only about 10 years.
There Is a Way, There Is Recourse, to Move Safely Back from the Edge
John, though, was not yet at stage 5. Dr. Vesta and the Curally team went to work, coordinating care with John’s physician, and coaching John through a lifestyle transformation of improved diet and exercise. It wasn’t easy, but it was a far better alternative to life on dialysis.
After several months, John’s results are remarkable. His kidney function improved 40 percent, and he is on his way to having healthy, fully functioning kidneys.
John’s experience—from Dr. Vesta’s claims review and recognition of a problem through the team’s intervention, coordination with John’s physician, and personalized care management—is atypical in healthcare today. It is, however, more commonplace for participants whose employers partner with Curally.