By OPEN MINDS Circle
On February 22, 2023, Somatus (a value-based kidney care company) and UnitedHealthcare (UHC) expanded their partnership to UHC members in five new states: Georgia, Maryland, Tennessee, Virginia, and the District of Columbia. Additionally, UnitedHealthcare Medicare Advantage members in the following new locations will have access to Somatus: Connecticut, Illinois, Massachusetts, New Jersey, and Rhode Island. Qualified UHC Medicare Advantage and UnitedHealthcare Dual Special Needs Plan (DSNP) members will still have access to the Somatus program in those markets, as well as UHC’s Oklahoma market. The Somatus services are for people chronic kidney disease (CKD) or end-stage kidney disease (ESKD).
With this UHC geographic expansion, Somatus now manages care for more than 160,000 people in 36 states and the District of Columbia. Somatus currently partners with ten national and regional health plans, including UHC, Anthem, and Centene subsidiaries. It also partners with several dozen hospitals and health systems, and more than 19,000 primary care provider organizations, nephrologists, and other specialists. Somatus has not disclosed its reimbursement arrangements. The payers have not disclosed how often cost outcomes are assessed.
The Somatus model focuses on improving care outcomes, experience, and access for members while facilitating continuity of care across settings. It offers vertically integrated clinical services and technology to delay or prevent disease progression, improve quality of care, improve care coordination, and increase the use of home dialysis modalities and rates of kidney transplantation. Its programs are supported by community-based care teams which act as an extension of a physician’s practice to help close care gaps, enhance disease management, improve clinical outcomes, reduce avoidable hospitalizations, and lower total cost of care. The goal is to improve care management for the member’s kidney disease and other comorbid health conditions.
After an eligible member enrolls in the Somatus program, the member is paired with a local Somatus care team that provides holistic care management; education about CKD, treatment options and diet; and help transitioning from hospital to home. The care team includes a nurse care manager, a community health worker, a renal pharmacist, a renal dietitian, and a social worker (who assists with transportation, food or other issues that impair the member’s compliance with treatment).
UnitedHealthcare is the health benefits business of UnitedHealth Group. UnitedHealth Group also includes Optum, a business that delivers care aided by technology and data, empowering people, partners and providers with the guidance and tools they need to achieve better health. It offers a full spectrum health benefit programs for individuals and employers, and contracts directly with more than 1.2 million health care professionals, and 6,500 hospitals. UnitedHealthcare serves more than 12 million Medicare beneficiaries.
For more information, contact:
- Juston Reeder, Vice President, Marketing and Communications, Somatus, 1861 International Drive, Suite 600, McLean, Virginia 22102; 571-992-0600; Email: media@somatus.com; Website: https://somatus.com/
- Will Shanley, Communications Director, UnitedHealthcare, Email: will.shanley@uhc.com; Website: https://www.uhc.com/
Editor’s Note: This article was updated on April 11, 2023 to correct the new states.