AZ Blue partners with Monogram Health to offer kidney care management to its members

Steven Loeb · January 29, 2024 · Short URL:

Monogram will be available to AZ Blue's network of nearly 2 million members

Around 14% of adults in the U.S., or over 35 million people, are estimated to have chronic kidney disease (CKD), which are the 8th largest cause of mortality in both sexes combined. They're also the 10th largest cause of years of life lost, and the 10th largest cause of disability-adjusted life years. 

Monogram Health is a company looking to tackle this problem by providing value-based in-home care and benefit management services for patients living with polychronic conditions, notably, CKD and end stage kidney disease (ESKD).

To date, over 66,000 patients across 35 states have used Monogram's services and now the company will be growing that number as it announced a partnership with Blue Cross Blue Shield of Arizona (AZ Blue) on Monday.

Through this partnership, AZ Blue will use Monogram's network of in-home providers and support services to improve the care of their nearly 2 million members. In addition, as part of this collaboration, Monogram Health will also assume full financial risk for AZ Blue's Health Choice Pathway D-SNP Product members with kidney disease; that will give patients across eight counties in Arizona access to Monogram's services, including evidence-based clinical pathways and protocols, in-home specialty care, complex case and disease management, and medication therapy management.

Founded in 2019, the Nashville-based Monogram and its employed providers treat CKD and ESKD, along with co-morbidities such as complex metabolic, pulmonary, and cardiovascular diseases. The company's clinical programs include case management, disease management, utilization management, and medication therapy management to enable the delivery of value-based care.

Patients who use Monogram get access to a care team that includes a registered nurse care manager and a social worker for home visits; the team is led by a nephrologist and supported by cardiologists, internal medicine specialists, geriatricians, dieticians, care coordinators, pharmacists, and additional social workers.

Monogram helps patients keep track of medications and appointments, arrange transportation if needed, and access additional services as necessary. Patients also get access to education services that can help answer questions about treatment options, and provide guidance for  kidney care and chronic condition management.

For providers, Monogram offers them predictive analytics, as well a value-based reimbursement so they construct partnerships with health plans.

Monogram Health has numerous value-based partnerships with leading health plans, integrated delivery systems, and risk-bearing entities, including Cigna, Humana, Aligion Health, AdventHealth, Aetna, DevotedHealth, and the U.S. Department of Veterans Affairs.

So far, the company has been able to double planned dialysis transitions, tripled rates of home dialysis, and halved readmission rates from the national average for its current plan partners.

"We're proud to embark on this value-based care journey with Monogram Health to provide improved patient experiences, achieve better health outcomes and reduce variability in care," Shawn Nau, General Manager, Medicaid Segment at Blue Cross Blue Shield of Arizona, said in a statement.

"We are firmly committed to delivering innovative services, personalized care management and support to the members we serve across Arizona. By combining AZ Blue's high-value, cost-effective product with Monogram's innovative, evidence-based approach to in-home care delivery, we'll be able to dramatically improve the quality of life for our members navigating complex chronic and end stage kidney disease."

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