VILLAGEHEALTH DM, LLC
DENVER, CO

VillageHealth® is the renal population health management division of DaVita Inc., a Fortune 500® company. We are the country’s largest renal provider accredited by the National Committee for Quality Assurance (NCQA). Our more than 600 teammates integrate and manage care for patients with late-stage chronic kidney disease (CKD) and for patients with end stage renal disease (ESRD) who depend on life-sustaining dialysis. VillageHealth has no financial arrangements with other organizations to advertise, market or promote products or services. VillageHealth does not advertise, market or promote specific products or services to patients or providers. I was blessed the day VillageHealth first called me. The nurses are always on top of my condition. They tell me what I need to hear and not what I want to hear. I have a scale and I use it every day to stay healthy. VillageHealth always gives me important advice on my fluids, swelling, breathing and my diabetes. I have not been in the hospital nearly as much as I was before VillageHealth started helping me. My heart failure is under better control now. I do not know what would happen to me without the VillageHealth program. It is a very helpful and important program. Highmark, a large Blue Cross Blue Shield-affiliated company headquartered in Pittsburgh, recognized that achieving the Triple Aim for their renal patients, one of their most medically complex outlier populations, would be nearly impossible with a traditional care management approach. In partnership with VillageHealth, Highmark has improved ESRD patient quality of care, enhanced patient quality of life, and achieved 21 percent addressable cost savings. An ESRD Seamless Care Organization (ESCO) is a group of dialysis facilities, nephrologists and other health care providers working together to integrate care for dialysis patients. ESCOs are part of Medicare’s Comprehensive ESRD Care Model and were created to measurably improve clinical outcomes and patient experience while reducing total cost of care for an attributed population. As the industry’s first disease-specific Medicare accountable care organizations (ACOs), ESCOs provide an opportunity to demonstrate success in integrating care for Medicare’s ESRD population in select geographies and to further validate the value of Medicare creating a national integrated care reimbursement model that can scale to serve all ESRD patients. With more than a decade of proven experience integrating care and managing total cost of care for ESRD patients on dialysis, we are uniquely qualified to realize the potential of the ESCO model in collaboration with our nephrologist partners and DaVita dialysis and health system ESCO joint venture partners. Our success managing the renal population is founded on access to patients 12-15 hours a week and scale that allows us to continually innovate to evolve our renal-specific care management capabilities and predictive analytics and advanced technology.  VillageHealth supplements the ESCO dialysis clinic teams by coordinating care inside the dialysis clinic with care and patient needs outside the dialysis clinic. VillageHealth’s nurses and nurse practitioners collaborate with patients, nephrologists, other care providers and dialysis care teams to create and manage an integrated care plan to help meet the unique medical, social and behavioral needs of each patient.  Members enrolled in our health plan partners’ C-SNPs benefit from additional care coordination and management provided by VillageHealth. VillageHealth supplements the dialysis clinic teams by coordinating care inside and outside the dialysis clinic. VillageHealth’s nurses and care coordinators collaborate with patients, nephrologists, other care providers and dialysis care teams to create and manage an integrated care plan to help meet the unique medical, social and behavioral needs of each patient. Through this unique model, patients under VillageHealth’s care have lower hospitalization rates and catheter rates than those in traditional Medicare fee-for-service. ESRD C-SNPs are Medicare Advantage plans designed specifically to meet the needs of members with ESRD.  ESRD C-SNPs represent a unique opportunity to provide integrated care to ESRD patients, as the coverage available to eligible members extends beyond that of a typical Medicare Advantage plan, including additional benefits designed to meet ESRD members’ unique needs.  VillageHealth’s Renal Population Health program can help integrate and manage care: Our trained integrated care team collaborates with patients, caretakers, physicians and dialysis care teams to establish and manage a care plan to meet the unique medical, social and behavioral needs of each patient. By focusing on the root causes of unnecessary hospitalizations such as unplanned dialysis starts, infection, fluid overload and medication management, our care teams can help reduce hospitalizations and improve the overall health of CKD and ESRD patients. Patient Pathways, a provider-neutral discharge-planning and placement program, can enhance a hospital’s case management team capacity while providing specialized support by: Pathways can complement the case management staff with the support of a trained placement expert to educate and place your most complex and time consuming dialysis patients. This additional support can save an average of six hours for each discharge that includes a dialysis placement, resulting in less of a burden on staff. This can also allow for better optimization of the existing case management team and help streamline workflows for the complex ESRD population. We focus exclusively on renal patients, serving as a single point of contact for the case management staff and nephrologists. Our teammates will coordinate across the local outpatient renal community, while using our proprietary workflows and best practices to help navigate and overcome common placement-related barriers to discharge.