March is National Kidney Health month in the United States. Last year, we talked about how daily healthy habits can slow the progression of Chronic Kidney Disease (CKD). While behavior change is a challenge faced universally, it is important to take into account how social factors create additional obstacles when it comes to managing kidney care.
Although as many as 1 in 7 US adults have CKD, about 9 out of 10 of those are not aware. That means more than 30 million people are living with CKD and don’t know it. How are this many people falling through the cracks?
The National Institute of Health Diabetes and Digestive and Kidney Diseases (NIHDDK) recommends: engaging in your health; following your care plan; and creating a healthy kidney plan. While there are many human factors that prevent proper CKD care, the underlying social determinants have proven to make care plan adherence increasingly complex.
In the United States, there are prevalent racial disparities in the rates of chronic illness and CKD is no exception. Diabetes and High Blood pressure are common comorbidities linked with the progression of kidney disease, all of which have disproportionate rates in Black, Hispanic, and Indigenous populations.
Rates of Kidney failure compared to white, non-hispanic populations is-
According to a study analyzing CKD trends among racial and ethnic groups and socioeconomic status, found that rates of CKD have stabilized among most racial and ethnic groups with the exception of Mexican Americans. Rates of CKD doubled between 1994 and 2016 for Mexican Americans and disparities between educational attainment and income level remained consistent throughout the study.
Rates are higher in these populations due to years of structural racism, social and socio-economic inequity. Individuals that fall in these categories make up a large portion of member populations that disengage with their care plans due, in part, to a history of not feeling adequately seen and cared for.
Caring for CKD is complex and costly for people. To properly manage Chronic Kidney Disease, one must take into consideration the costs associated with medications, access to nutrition and availability of transportation to provider appointments. There are several medications that need to be refilled and taken on a regular basis, on top of medication for other conditions. Medicine to control glucose, blood pressure, cholesterol, and a diuretic to help with fluid retention means 4 or more pills at a time.
For End Stage Renal Disease (ESRD)– stages 4 and 5 of Chronic Kidney Disease– dialysis is required. This requires 3 trips to a dialysis center every week for 4 hours of blood filtration and costs $500 per session if the patient doesn’t have insurance.
Between medications, doctor’s visits and dialysis, the cost adds up quickly and can be impossible to sustain for lower income individuals even though missing treatments increases risk of hospitalization or death two fold.
Reliable and consistent transportation is crucial but can be difficult for lower income patients to access. In a study conducted in South Carolina, Social Workers that assist with dialysis patients noted an average of 4.5 dialysis appointments per month are missed due to issues with transportation.
Dialysis helps patients with ESRD filter their blood and missing these appointments can lead to high levels of potassium and phosphorus which can cause heart arrhythmias, heart attacks, weakened bones, heart disease, and death.
Individuals with CKD also need to be extra conscious of what they are eating, limiting intake of sodium, potassium, even protein intake. On average, healthy foods cost 2x more per serving than pre-packaged or processed foods. With the added complications around healthy eating for those living with CKD, it can be difficult to follow an eating plan.
Care plans for Chronic Kidney Disease include medications, costs, time, transportation and dietary considerations. The sheer number of details can be overwhelming and even more so for those struggling to make ends meet.
The support from others is what really shapes success in managing chronic conditions. With 38% of CKD patients being over 65, seniors may need additional help tracking their medications, noting any changes, providing transportation to and from dialysis or self-administering home dialysis.
Outcomes are detrimentally impacted when people with Chronic illnesses don’t have a solid support system. Chronic diseases, like CKD can be very isolating because having a regular schedule is difficult around medication requirements, dietary restrictions, and scheduling dialysis as well as managing the physical symptoms such as fatigue and negative body image.
Many traditional healthcare programs are centered around education (about conditions) and reminders (to take their meds or visit the doctor). These programs miss the human element of chronic care management: while people may understand what they are supposed to do, in the moment, life can make those decisions challenging. Utilizing the principles of Behavioral Economics, Wellth is able to meet members where they are by understanding the reasons people struggle to follow a care plan of diet, medication, and regular treatment.
Wellth programs offer a monthly reward to members; rewards are kept based on completion of daily care plan tasks. When tasks are completed, the member “keeps” $2. If a member misses the daily task check in, $2.00 are removed from the monthly reward. This is the Endowment Effect, one principle of behavioral economics. The endowment effect recognizes that people are 2x more likely to want to keep something they have than gain something new. As checking in becomes a habit, better results follow, ultimately making the outcomes themselves the rewards.
“You folks are the best. I had my annual checkup on Wednesday with my doctor and bragged how you folks have motivated me to take my meds daily and I feel so much. better my a1c is 5.5, my sugar was 89, potassium back in line, my albumin 4.1…I owe my health to you folks”
A live member support team provides personalized support for Wellth members. When there is any trouble with the program they have a real person they can talk through any issues with. Similarly, if too many check-ins are missed they have a support specialist personally reach out to them to see if they need any assistance getting back on track.
Wellth members spend these rewards on categories that directly impact Social Determinants of Health. Almost 70% of rewards go towards food and groceries, 20% for Household needs and the rest to transportation and home repairs. These rewards help members with chronic conditions like CKD live healthier lives, create daily habits, and ultimately improve health outcomes.
“The money that I receive I use for food since I am not on food stamps or any other help. I have 14 years with dialysis since 2007 and I haven't worked since. That is why I joined Wellth. “
Wellth members with CKD have adherence levels of about 86% and Wellth programs have reduced hospitalizations by 43%. These are life changing results for people with chronic conditions because this ultimately is the key to a longer and happier life.