The Peterson Health Technology Institute (PHTI) has assessed virtual chronic kidney disease (CKD) management solutions, finding no consistent evidence that they slow disease progression or generate meaningful population-level cost reductions compared with standard care.
The assessment evaluated DaVita Integrated Kidney Care, Evergreen Nephrology, Healthmap Solutions, Interwell Health, Kidneylink, Monogram Health, Somatus and Strive Health. It examined patients with CKD stages 3–5, drawing on 34 clinical studies and multi-year data from CMS’s Kidney Care Choices model.
Across comparative studies, virtual interventions did not significantly change annual estimated glomerular filtration rate (eGFR) decline or consistently reduce progression toward end-stage kidney disease. PHTI also found little difference in use of kidney-protective therapies. In 2022 and 2023 Comprehensive Kidney Care Contracting (CKCC) data, differences in prescribing ACEi/ARBs and SGLT2 inhibitors between participating and matched non-participating practices remained below one percentage point.
Evidence varied substantially between companies. Five of the eight assessed organizations—DaVita IKC, Evergreen, Kidneylink, Monogram and Somatus—had no peer-reviewed clinical evidence meeting PHTI’s review criteria. Strive Health had the strongest evidence base, including statistically significant reductions in 30-day post-discharge readmissions and slower eGFR decline in a pre-post cohort, although PHTI identified limitations affecting generalizability.
The assessment did identify improvement in planned dialysis transitions. CKCC participants recorded a 12.4-percentage-point higher optimal end-stage kidney disease start rate in 2023, including outpatient dialysis with permanent vascular access and preemptive transplantation.
However, PHTI found the population-level financial effect limited because only 0.7%–1.9% of attributed CKD patients begin dialysis annually. Estimated gross annual savings were $53 per member in Traditional Medicare, $62 in Medicare Advantage and $401 in commercial plans before program-related costs.
PHTI attributed some shortcomings to incentives and patient identification. Approximately 87% of adults with CKD are unaware they have the condition, limiting vendors dependent on diagnosed patients and nephrology partnerships. The institute recommended shifting value-based contracts toward patient-level milestones, including earlier kidney testing, primary-care initiation of kidney-protective medications and utilization-linked cost measures.
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