Guest User 2/19/21 Guest User 2/19/21

Monogram Health secures $8.1 million debt round, inks deal with Scan Group

Senator Bill Frist is the Nashville Business Journal's 2017 Health Care Heroes Lifetime Achievement honoree, NATHAN MORGAN | FOR THE NASHVILLE BUSINESS JOURNAL

By Joel Stinnett – Reporter, Nashville Business Journal

Published via Nashville Business Journal, on 02/19/2021

One of Nashville’s newest health care companies has secured funding from one of the nations largest not-for-profit health plans.

Monogram Health has received a strategic investment from Scan Group, who’s holdings include Scan Health Plan (stylized: SCAN Health Plan), according to a news release. Terms of the deal were not disclosed.

According to an filing made Thursday with the U.S. Securities and Exchange Commission, however, Monogram raised $8.1 million of a possible $10.1 million round of debt funding at the end of January.

It’s not clear if the two deals are connected and Mongram did not immediately comment on the SEC filing.

The investment comes less than a year after Mongram closed on a $7 million round of funding led by Frist Cressey Ventures and Norwest Venture Partners, which brought the company’s lifetime cash raised at the time to $12 million.

Founded in January 2019 by Michael Uchrin and Frist Cressey co-founder Sen. Bill Frist, the kidney disease management company works with health insurance plans, such as Humana Medicare Advantage and Commercial, to care for chronic kidney disease patients inside their homes across 20 states. Depending on the stage of the patient’s disease, Monogram works to either stabilize a patient’s disease progression, prepare the patient for dialysis or transplant or improve treatment results for patients already on dialysis.

Scan is a not-for-profit Medicare Advantage plan, with more than 220,000 members in California, according to the release. The plan’s investment in Monogram marks the first time Scan has invested in an outside entity.

In May, Uchrin told the NBJ that Monogram was preparing for a period of rapid growth in part because of the enactment of the 21st Century Cures Act, which allows Medicare beneficiaries with end-stage renal disease to enroll in 2021 Medicare Advantage plans through private insurers for the first time.

“We are pleased to partner with Scan to offer advanced solutions that expand access to evidence-based therapies and proactive planning,” Frist, Monogram’s chairman, said in the release. “By leveraging the power of Medicare Advantage plans to provide better care to older adults at a lower cost, both of our organizations will work together to ensure that people with kidney disease can take greater control of their health and quality of life.”

In addition to the funding, Scan and Monogram have signed a strategic agreement to “to work together to improve care for older adults with kidney disease, according to the release.”

Mike Uchrin, Monogram Co-founder and CEO

"The Covid-19 pandemic has put a spotlight on the home as a safe health care setting for dialysis and other kidney-related care," Uchrin said in the release. "Monogram’s solutions empower vulnerable patients with renal disease to be treated in the comfort and safety of their own homes. This innovative approach to managing kidney care delivery is improving health outcomes for a population that drastically needs and deserves better care."

Guest User 2/15/21 Guest User 2/15/21

SCAN Group Makes Strategic Investment in Monogram Health

Healthcare non-profit makes first-ever outside investment in Nashville-based company that’s transforming care for patients with chronic kidney and end-stage renal disease

LONG BEACH, Calif., Feb. 16, 2021—SCAN Group, whose holdings include SCAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage plans, has made a strategic investment in Monogram Health. Monogram Health is a leading kidney care management company providing at-home care and data-driven solutions for patients living with chronic kidney and end-stage renal disease.

The investment marks the first time SCAN, which focuses on healthcare for older adults, has made an investment in an outside entity. SCAN Group made the investment as part of its larger diversification strategy, through which it will build and invest in new companies to support healthier aging. After inking the deal, SCAN and Monogram also signed a strategic agreement formalizing the two entities’ intent to work together to improve care for older adults with kidney disease.

“This strategic partnership marks an important new chapter for SCAN and a valuable investment in the health of America’s seniors,” said Dr. Sachin Jain, president and CEO of SCAN Group and SCAN Health Plan. “SCAN recognizes the tremendous challenges faced by the growing population of patients experiencing chronic kidney and end-stage renal disease, and we believe Monogram Health is doing the right work at the right time to serve this patient population.”

Approximately 31 million Americans are living with chronic kidney disease and end-stage renal disease, according to the United States Renal Data System. Of those, more than 26 million are over age 65.

Monogram Health partners with health plans, physician practices, dialysis providers and clinically integrated health systems to develop personalized care plans that keep patients independent and at home. Because of Monogram’s unique, in-home care model, the readmission rate for its patients is half the national average.

"We pride ourselves on working with and building innovative companies that are truly transforming the delivery of healthcare,” said Dr. Jain. “We share Monogram’s vision of making kidney care more accessible to more people, lowering the cost of care, and at the same time improving both quality of life and health outcomes.” Jain noted that about 90% of Monogram patients are enrolled in Medicare Advantage plans, SCAN’s traditional focus and the area in which it has developed a record of expertise.

“We are pleased to partner with SCAN to offer advanced solutions that expand access to evidence-based therapies and proactive planning,” said former U.S. Sen. Bill Frist, M.D., co-founder of Frist Cressey Ventures and Monogram Health’s board chairman. “By leveraging the power of Medicare Advantage plans to provide better care to older adults at a lower cost, both of our organizations will work together to ensure that people with kidney disease can take greater control of their health and quality of life.”

"The COVID-19 pandemic has put a spotlight on the home as a safe healthcare setting for dialysis and other kidney-related care," said Michael Uchrin, Monogram Health’s CEO and co-founder. "Monogram’s solutions empower vulnerable patients with renal disease to be treated in the comfort and safety of their own homes. This innovative approach to managing kidney care delivery is improving health outcomes for a population that drastically needs and deserves better care."

About SCAN Group

SCAN Group is a mission-driven organization that is tackling some of the biggest issues in health care for older adults. The core of SCAN Group is SCAN Health Plan, one of the nation’s foremost not-for-profit Medicare Advantage plans, serving more than 220,000 members in California. Independence at Home, a SCAN community service, provides vitally needed services and support to seniors and their caregivers regardless of plan membership. SCAN Group also invests in new companies to support healthier aging, offers education programs, community funding, volunteer opportunities, and other community services in support of its mission—keeping seniors healthy and independent. To learn more, visit scanhealthplan.com or follow us on Twitter @scanhealthplan.

About Monogram Health

Monogram Health is a leading kidney-disease focused benefit management and care delivery company. It provides an innovative renal care model and data-driven array of clinical managed services, including complex case and disease management, utilization management and medication therapy management to transform the delivery of care received by patients living with chronic kidney and end-stage renal disease. Partnering with health plans, physician practices, dialysis providers and clinically integrated health systems, Monogram Health provides patients with exceptional at-home individualized clinical managed services and Nephrology care delivery. Through the use of next generation artificial intelligence, evidence-based criteria and personalized care planning, Monogram Health’s model seeks to delay the progression of the disease, promote a seamless transition to dialysis, palliative care and/or pre-emptive kidney transplant and optimize health outcomes for patients with end-stage renal disease. Based in Nashville, Tenn. and privately held by Frist Cressey Ventures and Norwest Venture Partners, Monogram Health currently operates its renal disease benefit management programs and care delivery across 20 states in the U.S. and has built a national network of nephrologists that includes hundreds of leading kidney care specialists. To learn more about Monogram Health, please visit here.

SCAN Health Plan Media Contact:

Seffrah Orlando, sorlando@scanhealthplan.com 562.533.0641

Monogram Health Media Contact:

Sophie Moore, sophie@lovell.com

678.977.8647

Guest User 2/9/21 Guest User 2/9/21

Monogram Health Launches In-home and Virtual Kidney Clinic

New clinic expands access to care for growing population of patients with kidney disease

NASHVILLE, Tenn. February 9, 2021 -- Monogram Health today announced the launch of the Monogram Kidney Care Clinic, which will provide industry-leading access to patients facing kidney disease. The clinic allows those with kidney disease to receive preventive renal care as early as possible and allows for ready access to renal specialists for those with urgent kidney-related needs.

Currently operating in 10 states, the Monogram Kidney Care Clinic serves a growing national cohort of high-risk chronic kidney disease (CKD) and end-stage renal disease (ESRD) members enrolled in Medicare Advantage and managed Medicaid plans, following enactment of the 21st Century Cures Act. The clinic provides access to patients through in-home and virtual visits conducted by its team of kidney-focused physicians, nurse practitioners and other clinicians. The clinic’s telehealth capabilities will enable greater access for all kidney disease patients, including those living in remote or rural areas without local renal specialists.

“The Monogram Kidney Clinic complements our managed care services, by increasing access to nephrology services for those who need it,” said Chris Booker, a partner at Frist Cressey Ventures and co-founder of Monogram Health. “The clinic helps ease a national shortage in renal services, leading to more preventive medicine and greater access to urgent care for those with CKD and ESRD. By providing upstream care to patients dealing with early onset of kidney disease, we are taking on one of the toughest challenges in healthcare. As our board chairman, former U.S. Senate Majority Leader, and heart surgeon Bill Frist has said, ‘Healthcare, in its simplest of forms, is people helping people.’ That’s the mission of the clinic.”

Early nephrologist engagement helps patients to understand kidney disease, delay its progress and engage in early planning for renal replacement therapy or conservative care. The Monogram Kidney Clinic will collaborate with nephrology practices across the country that are part of the Monogram Health nephrology care management network, acting as a supplementary access point to those patients already seen by a care management network nephrologist. “Our care managers serve as extensions of our partner nephrologists’ practices. Our clinic will do the same for those for practices that are working with Monogram to promote evidence-based care management,” said Kyle Cooksey, Monogram Kidney Care’s Senior Vice President and Administrative Officer.

“Our services are designed for kidney disease patients who are too sick for a standard primary care physician but are earlier in the progression of kidney disease than the average patient who first sees a nephrologist,” Cooksey said. “We also offer an urgent point of care for those with CKD and ESRD who are already under the care of a nephrologist. Our approach was developed by our team of industry leading nephrologists to harness the potential of our evidence-based dialysis criteria, best-in-class order sets and specialty services. But our biggest drivers are compassion and personalized kidney care.”

According to industry data, 30% of patients who experience kidney failure have never seen a nephrologist and 43% of CKD stage IV patients are unaware of their disease progression. Today, the prevalence of kidney disease is 1.5 times higher in Hispanic populations, and African Americans represent the highest affected group with 3.7 times the national average.

“Our focus is on improved health outcomes. We apply evidence-based criteria and use this to guide patients to the right care pathway. We promote planned dialysis starts, increase the use of home dialysis modalities and decrease unnecessary hospitalizations,” said Dr. Shaminder Gupta, Monogram Kidney Care’s Chief Medical Officer. “The COVID-19 pandemic has heightened the need for high-quality, in-home access to kidney health services. Monogram Kidney Care Clinic provides it.”

Monogram Kidney Care Clinic’s services are used by health plans across the country that serve Medicare, Medicare Advantage, Medicaid, and Commercial members. The clinic expects to be operating in a total of 20 states within the first half of 2021 and to serve thousands of health plan members. Based on national trends, the company estimates at least 50 percent of those members will not have seen a nephrologist in at least 12 months, making them ideal patients for engagement through Monogram Kidney Clinic.

To learn more about Monogram Kidney Care, please visit monogramhealth.com/care-clinic.

About Monogram Health

Monogram Health is a leading kidney-disease focused benefit management and care delivery company. It provides an innovative renal care model and data-driven array of clinical managed services, including complex case and disease management, utilization management and medication therapy management to transform the delivery of care received by patients living with chronic kidney and end-stage renal disease. Partnering with health plans, physician practices, dialysis providers and clinically integrated health systems, Monogram Health provides patients with exceptional at-home individualized clinical managed services and Nephrology care delivery. Through the use of next generation artificial intelligence, evidence-based criteria and personalized care planning, Monogram Health’s model seeks to delay the progression of the disease, promote a seamless transition to dialysis, palliative care and/or pre-emptive kidney transplant and optimize health outcomes for patients with end-stage renal disease. Based in Nashville, Tenn. and privately held by Frist Cressey Ventures and Norwest Venture Partners, Monogram Health currently operates its renal disease benefit management programs and care delivery across 20 states in the U.S. and has built a national network of nephrologists that includes hundreds of leading kidney care specialists. To learn more about Monogram Health, please visit here.

Dr. Shaminder Gupta (L), Monogram Kidney Care’s CMO, and resident nephrologist and Kyle Cooksey (R), Monogram Kidney Care’s SVP and Administrative Officer — **Dr. Shaminder Gupta** (L), Monogram Kidney Care’s CMO, and resident nephrologist and **Kyle Cooksey** (R), Monogram Kidney Care’s SVP and Administrative Officer

Thomas Lilly 1/25/21 Thomas Lilly 1/25/21

Monogram Health Announces Availability of Kidney Disease Care Coordination Services for Humana Members in Tennessee and Alabama

Broadened Collaboration Now Includes Four States

NASHVILLE, Tenn. — January 26, 2021 — Monogram Health announced today that it is expanding its collaboration with leading health and wellness company Humana Inc. (NYSE: HUM). Through an agreement now in effect, Monogram is providing care coordination services in Alabama and Tennessee for eligible Humana Medicare Advantage and Commercial health plan members with chronic kidney disease (CKD) or End Stage Renal Disease (ESRD). This is in addition to providing such services as previously contracted with Humana in two other states, Louisiana and Mississippi.

“It’s an honor to serve Humana members suffering from kidney disease. We are grateful to offer our services to them in Tennessee and Alabama,” said Sen. Bill Frist, M.D., Monogram Health’s board chairman. “Monogram shares Humana’s commitment to early detection of kidney disease, the slowing of its progression and empowering patients to make informed choices about their renal care.”

Monogram nurse case managers and social workers regularly visit CKD and ESRD patients in their homes, whether in urban or rural communities. The organization’s field staff work with Monogram physicians and nurses, and the patient’s primary care physician and nephrologist, to develop personalized care plans to keep patients as healthy as possible. These plans focus on care coordination strategies, such as medication and treatment compliance and monitoring of comorbidities. The goal is to treat patients more holistically, providing patient education about treatment options such as home dialysis, utilizing evidence-based care pathways, and taking into account social determinants of health.

“We are pleased to help Humana in its efforts to offer members evidence-based therapies and proactive planning,” said Monogram Chief Executive Officer Mike Uchrin. “It’s important that people with kidney disease have the chance to take greater control of their health and quality of life by using our program resources.”

About Monogram Health

Thomas Lilly 1/21/21 Thomas Lilly 1/21/21

Clinicians should personalize their approach to the management of kidney disease

Original article published via helio.com on 01/21/2020, found here

Article by Raymond Hakim, MD, 01/21/2021

As nephrologists know, the decline in kidney function is almost always a “silent disease,” and even patients who experience fatigue and low energy often attribute these symptoms to “getting old,” rather than as signs of illness.

When I practiced nephrology at Vanderbilt Medical Center, I was always surprised at the number of patients who presented to the chronic kidney disease clinic with comments such as, “I didn’t know I had kidney disease” or “I am still able to urinate, so why is my primary care physician referring me to a kidney disease clinic?”

These types of comments point to specific areas of needed improvement in kidney care, namely the need for earlier, proactive education of patients with CKD to encourage a greater awareness of the disease among these patients and the provision of evidence-based care to slow down progression of CKD. It is also important to educate them on their treatment options and optimize the care they may be receiving as patients with end-stage kidney disease.

Data from the 2020 Annual Data Report from the United States Renal Data System confirm that, of patients initiating dialysis for ESKD, more than 80% “crash” into dialysis during a hospital admission and end up initiating dialysis with a central venous catheter and all its acute and chronic complications, including high risk of infection and hospitalization.

Prior nephrology care

Even patients who have been followed by a nephrologist prior to ESKD often do not know all their treatment options, such as transplantation, home dialysis and, importantly, conservative care as an alternative to in-center dialysis.

These “crashes” into in-center dialysis not only impact the patient’s health adversely, resulting in multiple hospitalization episodes and high mortality, but also result in high cost of care, whether the patient has private insurance, Medicare or Medicaid.

Rather than “crashing“ into dialysis, patients with kidney disease should be empowered with knowledge and educated on ways they can slow down progression of their disease, learn about their treatment options if and when they progress to ESKD and help them prepare for whatever option they choose.

Alternative care models

A couple of years ago. I received a call from U.S. Senator Bill Frist, MD, who was my colleague when he worked at Vanderbilt as a heart transplant surgeon. We discussed this lack of knowledge among patients about their kidney disease, lack of awareness of non-dialytic or dialytic treatment options and lack of planning for evidence-based ESKD treatment pathways.

After a few meetings, he asked me to join a startup kidney care company, Monogram Health, that he founded. We shared the vision of raising awareness and knowledge of kidney disease in as many patients with CKD as possible and working with the nephrology community to raise the quality of care and patient satisfaction for patients with CKD and ESKD, resulting in better patient outcomes and cost efficiency in this expensive segment of health care.

Our model of care is simple: engage and talk with patients where they are most comfortable and relaxed – at home. We have done our in-home visits, using appropriate protections, even during the COVID-19 pandemic, because most patients prefer face-to-face interactions with medical personnel.

Raymond Hakim

Our interactions and educational program for patients follow three broad pathways that are complementary.

CKDelay focuses on patients with eGFR from 40 mL/min/1.73 m2 to less than 20 mL/min/1.73 m2.
ACT! is our advanced care transition program which focuses on educating patients with eGFR of less than 20 mL/min/1.73 m2 but who have not yet made an informed decision for their ESKD treatment options, including conservative kidney care, transplant or dialysis.
ECO or the ESKD care-optimization program is aimed at patients with eGFR less than 15 mL/min/1.73 m2 who have or have begun to experience kidney failure and for whom compliance with the right evidence-based treatment plan is critical.

CKDelay educates patients about lifestyle changes that can slow down progression of their illness, such as the following:

compliance with prescribed medication;
avoidance of OTC nephrotoxic medications;
diets that are rich in vegetables and fruits and low in sodium and protein; and
monitoring and recording their BP daily and if they have diabetes, monitor and record their blood sugar at least a few times daily to help their physician adjust their diabetes medication accordingly.

If the patient’s eGFR is 20 mL/min/ 1.73 m2 or less, in addition to the CKDelay education, the discussion focuses on their therapeutic options if and when they reach kidney failure.

The therapeutic options discussed are inclusive and consist of dialysis (with emphasis on home dialysis, transplantation preferably from a living related donor, which is an option that is also discussed with the patient’s next of kin) or conservative therapy for patients who are at an older age (> 75 years) or have multiple comorbidities that may significantly reduce their well-being and the quality of their lifestyle if they are initiated on dialysis.

Timely access placement

For those patients who elect dialysis as a modality choice, we discuss with them the need to prepare and initiate a timely access placement (AV fistula for those who elect hemodialysis and a PD catheter for those who elect the PD option), with emphasis on early placement of an AV fistula because they often require surgical revisions before the fistula matures and because placement of AV fistulas has been associated with improvement in eGFR.

For patients in our ECO program – those who have experienced kidney failure – we ensure they comply with an evidence-based pathway, be it conservative kidney care, transplant or post-transplant care. For those already on in-center dialysis, we emphasize the need for treatment compliance (and help with transportation issues if needed) and again, discuss the advantages of home dialysis if clinically appropriate.

This strong emphasis on home-based dialytic therapies has been reinforced by my colleague, Shaminder Gupta, MD, currently the medical director of Monogram Health, whose work was recently highlighted in an article in this publication.

Multidisciplinary care team

While most of these discussions with patients are performed by experienced nurses in the locality where patients live, social workers who can provide the patient with emotional support, particularly those with evident depression or denial of their health status and, for those who need it, help with transportation to medical entities or help them apply for external financial support.

When appropriate, patients with CKD (eGFR <30 mL/min/1.73 m2) who are not followed by a nephrologist are referred to the nephrology practice engaged with Monogram Health, to receive their nephrology-specific care. Monogram Health does not have a financial relationship related to the provision of dialysis. Monogram Health neither owns any dialysis facility nor benefits from any dialysis referral.

Our model of care is simple. Equally important, it is effective. We have been able to engage with more than 70% of patients referred or identified by a health plan as having CKD and doubled the rate (to more than 40%) of patients who initiate planned dialysis, with 28% initiating home dialysis (two to three times higher than the national average), resulting in a significant decline in hospitalizations and re-hospitalizations.

More than 20% of patients choose conservative therapy after they (and their next of kin) are educated on the risks and benefits of dialysis as a therapeutic option.

With all these positive patient outcomes, our “at-risk” payment model is performing well, confirming the principle of “doing well by doing good.”

For more information:

Raymond Hakim, MD, PhD, is an adjunct clinical professor at Vanderbilt University School of Medicine and Chief Medical Officer for Monogram Health.

Raymond Hakim, MD, Monogram Health Chief Medical Officer — Raymond Hakim, MD, Monogram Health
Chief Medical Officer

Anthony DeCosta 12/1/20 Anthony DeCosta 12/1/20

Monogram Health Receives HITRUST CSF® Certification

Kidney care management organization meets rigorous data security criteria

NASHVILLE, Tenn. – December 1, 2020 – Monogram Health announced today that the organization has received HITRUST CSF® Certification, following a review of the company’s systems and controls for protecting electronic health records and other sensitive data.

“Strong information security controls are critical to population health management,” said Chris Chi, Monogram Health’s Chief Operating Officer. “Our company’s health plan clients and plan members entrust us with their data. HITRUST certification underscores our commitment to patient privacy and data security.”

Monogram uses its advanced, proprietary artificial intelligence systems to identify the potential care needs of patients with kidney disease. Monogram’s care team – made up of physicians, nurse care managers and social workers – partners with nephrologists to ensure medication and treatment compliance and adherence to evidence-based care pathways. The specialized care team also assesses health drivers, such as appropriate nutrition, exercise, and other social determinants of health, through regular visits with patients in their homes.

The HITRUST CSF® Certified Assurance Program verifies that the organization's development, security, and compliance protocols meet key regulations and industry-defined requirements for data security and appropriate risk management. The certification encompasses HIPAA and numerous other federal and state regulations and standards for protecting sensitive patient data. Certification of Monogram Health’s cybersecurity effectiveness involved an end-to-end review of the company’s information technology systems, including its electronic care management system, software tools, cloud and data storage environments, servers, hardware, user workstations and encryption protocols.

"HITRUST is the industry gold standard for information security,” said David Hoffmann, Monogram Health’s Vice President of Information Technology. “Achieving HITRUST certification gives our clients peace of mind about their data and our safeguards to protect it.”

About Monogram Health

Media Contact:
Monogram Health
Sheila Biggs
312.837.3458
sbiggs@jarrardinc.com

Anthony DeCosta 10/20/20 Anthony DeCosta 10/20/20

Monogram Health Announces NCQA Population Health Program Accreditation

Monogram Health demonstrates commitment to quality and population health-based care model through receipt of NCQA accreditation

NASHVILLE, Tenn. – October 20, 2020 – Monogram Health announced today that the organization has received Population Health Program accreditation from NCQA, in furtherance of part of the company’s value-based kidney benefit management services. Achieving NCQA accreditation underscores Monogram Health’s dedication to population health management, improved outcomes, and continuous quality improvement for health plan members suffering from chronic kidney disease and end stage renal disease. NCQA issued the accreditation following a detailed review of the company’s operational processes, clinical benefit management policies and other practices.

“Achieving NCQA accreditation is a testament to the quality work Monogram Health does each day to serve the needs of our members, providers, and health plan clients,” said Dr. Raymond Hakim, Monogram’s Chief Medical Officer. “By leveraging our in-home care model, evidence-based clinical criteria and advanced analytics, we are able to drive improved outcomes and reduce unnecessary costs.”

Monogram uses its advanced, proprietary artificial intelligence systems to identify the potential care needs of patients with kidney disease. Monogram’s care team – made up of nurse care managers and social workers – partners with nephrologists to ensure medication and treatment compliance and adherence to evidence-based care pathways. The specialized care team also assesses health drivers, such as appropriate nutrition, exercise and other social determinants of health, through regular visits with patients in their homes.

NCQA is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, managed behavioral healthcare organizations, preferred provider organizations, new health plans, physician organizations, credentials verification organizations, disease management programs and other health-related programs.

“The Population Health Management programs moves us in greater alignment with the increased focus on person-centered population health management,” said Margaret E. O’Kane, President, NCQA. “Not only does it add value to existing quality improvement efforts, it also demonstrates an organization’s highest level of commitment to improving the quality of care that meets people’s needs.”

About Monogram Health
Monogram Health is a leading kidney-disease focused benefit management and care delivery company. It provides an innovative renal care model and data-driven array of clinical managed services, including complex case and disease management, utilization management and medication therapy management to transform the delivery of care received by patients living with chronic kidney and end-stage renal disease. Partnering with health plans, physician practices, dialysis providers and clinically integrated health systems, Monogram Health provides patients with exceptional at-home individualized clinical managed services and Nephrology care delivery. Through the use of next generation artificial intelligence, evidence-based criteria and personalized care planning, Monogram Health’s model seeks to delay the progression of the disease, promote a seamless transition to dialysis, palliative care and/or pre-emptive kidney transplant and optimize health outcomes for patients with end-stage renal disease. Based in Nashville, Tenn. and privately held by Frist Cressey Ventures and Norwest Venture Partners, Monogram Health currently operates its renal disease benefit management programs and care delivery across 20 states in the U.S. and has built a national network of nephrologists that includes hundreds of leading kidney care specialists. To learn more about Monogram Health, please visit here.

About NCQA
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website (ncqa.org) contains information to help consumers, employers and others make more informed health care choices. NCQA can be found online at ncqa.org, on Twitter@ncqa, on Facebook at facebook.com/NCQA.org and on LinkedIn at linkedin.com/company/ncqa.

Anthony DeCosta 6/16/20 Anthony DeCosta 6/16/20

Monogram Health and Banner – University Health Plans Announce Innovative Kidney Care Partnership

Through combined expertise, organizations will further improve the quality of life for patients living with chronic kidney disease in Arizona

NASHVILLE, Tenn. and PHOENIX – June 16, 2020 – Monogram Health and Banner—University Health Plans (B – UHP), a division of Banner Health, announced today an agreement that will improve the coordination of vital care for B – UHP members living with chronic kidney disease (CKD) and end-stage renal disease (ESRD).

“We’re excited to partner with Monogram to transform the delivery and management of kidney care,” said Banner University Health Plans. “Together, we have the unique opportunity to improve the lives of those suffering from kidney failure, increase access to their clinical care team and more deeply engage patients in their treatment plans.”

Banner University Health Plans noted that the partnership with Monogram emphasizes home-based benefit management and home dialysis therapies, in order to improve outcomes and lessen the risk of communicable disease transmission. “COVID-19 has put a spotlight on home-based care and the ability to treat kidney disease outside of the dialysis clinic environment.”

The Monogram-B – UHP partnership is designed to delay the progression of CKD, improve the timeline of care for those at risk of kidney failure, as well as elevate the quality of life for patients and leverage the benefits of in-home therapies for those with ESRD. Members of B – UHP’s Medicare Advantage DSNP, Complete Care and Long-Term Care health plans with late-stage CKD or ESRD will now have the option of receiving Monogram’s services. In addition to receiving regular home benefit management visits, these patients will have 24/7 access to Monogram’s support team, who help manage care with the patient’s nephrologists and dialysis providers and promote adherence to treatment plans through education and coaching.

“Partnering with an esteemed organization such as B – UHP is an honor,” said Senator Bill Frist, M.D., Monogram Health’s board chairman. “Through innovative and collaborative partnerships like this, we’re able to improve patient outcomes by addressing the unique needs of those who suffer from kidney disease. We believe that higher quality of care means that patients receive the right care at the right time, ultimately lowering costs, and we look forward to bringing our model to more patients.”

Monogram uses advanced artificial intelligence to identify the potential care needs of patients with kidney disease. Monogram’s care team – made up of nurse care managers and social workers – partners with nephrologists to ensure medication and treatment compliance. The specialized care team also assesses health drivers, such as appropriate nutrition, exercise and other social determinants of health through regular visits with patients in their homes. Through the partnership with B – UHP, Monogram will use advance payment models that reward nephrology practices for delivering high-quality, costefficient care.

“Monogram’s unique approach to partnering with nephrologists and dialysis providers builds relationships between nurses and patients, leading to better health outcomes and reduced costs,” said Dr. Raymond Hakim, Monogram’s Chief Medical Officer. “Through our highly focused care delivery network, we confidently drive improved patient outcomes and take on the financial risk around total cost of care.”

The partnership with B – UHP comes as greater attention is dedicated on a national scale to the care of those suffering from kidney disease. Last July, the Executive Order on Advancing American Kidney Health was issued seeking to transform kidney care in the United States by creating provider payment models that reward kidney care specialists for achieving high-quality patient outcomes and cost efficiency. This effort is extremely important to both care quality and cost, as the Center for Disease Control reported that in 2017, approximately $120 billion was spent annually for Medicare program beneficiaries with CKD (more than $84 billion) and ESRD (an additional $36 billion).

“We are proud to be working with B – UHP and Monogram Health to strengthen our ability to further address the growing healthcare needs of Arizona residents living with chronic kidney disease and endstage renal disease,” said Jami Snyder, director of the Arizona Health Care Cost Containment System. “AHCCCS has proven to be a leader in innovation, and through Monogram Health’s pioneering care model, led by nephrologists, we can provide these patients with the essential access points of care in their own homes.”

About Banner—University Health Plans
Banner—University Health Plans (B – UHP) is a managed care organization and part of Banner Health (Banner). As the largest employer and Medicaid provider in Arizona, Banner has more than 30 years of experience in Arizona's healthcare and labor markets. As a Banner division, B – UHP is the only locally owned plan focused exclusively in Arizona and is a recognized Medicaid managed care leader. In 1985, B – UHP began as an early Medicaid contractor and has a history of successful operations in Medicaid and Medicare. B – UHP owns and operates: Banner–University Family Care (B – UFC/ACC), an AHCCCS Complete Care plan; Banner – University Family Care (B – UFC/ALTCS), an AHCCCS Long Term Care plan; and Banner – University Care Advantage (B – UCA), a Medicare Advantage Dual Special Needs Plan (DSNP). B – UHP fosters a member-centric culture, is an active community partner, and is on a mission to make health care easier so life can be better.

Anthony DeCosta 5/11/20 Anthony DeCosta 5/11/20

Nearly 40% of This Nephrologist’s ESKD Patients Dialyze at Home

By Jody A. Charnow via Renal and Urology News

Shaminder Gupta, MD, is a nephrologist who practices in Houma, Louisiana. He serves as the section chief at his hospital and also as Corporate Medical Director at Monogram Health, a renal disease care management company. He tells Renal & Urology News how he developed and manages a home dialysis program in which approximately 40% of his patients with end-stage kidney disease (ESKD) participate, far above the national average in the United States. As of December 31, 2017, only 2% of hemodialysis (HD) patients used home HD, according to the US Renal Data 2019 Annual Data Report. Another 7.1% of ESKD patients used peritoneal dialysis, which is a home dialysis modality.

How are you able to care for such a relatively high proportion of your patients receiving home dialysis?

Dr Gupta: I practice in a rural part of Louisiana. On the first pass, it may seem that home dialysis would be challenging in these patients for multiple reasons: poor socioeconomic status, large distances from patient to dialysis unit, lower education. I have found that this patient cohort is extremely resilient and capable of self-care. They are willing to learn and care for themselves, and there is a deep sense of family.

Our nurses are the key to having patients choose home options by constant encouragement and support. We do not promise patients it will be easy in the beginning, but we do promise it will be better. Once the home program matures past a critical mass, it is actually easier for the nurses as a team because of the self-care that patients do. Many patients only come in for the monthly visit and we do check-ins. The ones who need more attention can usually be managed by phone or telehealth.

What prompted you to establish a home dialysis program?

Dr. Gupta: Our part of the state is also very prone to weather events, and this makes home options very attractive. I started this program in 2008 with the idea that all patients can do home dialysis and they all should be offered home dialysis. I do not let my own biases get in the way, and I want all patients to consider home dialysis as a first option. For some, it is easy. They have support and are engaged. Others are very reluctant, but we continue to encourage and push them from early CKD stage 4 to consider this option.

How big a role does telemedicine play in your ability to manage these patients?

Dr. Gupta: For my practice, telemedicine has not been a large component. We sometimes utilize it, but most patients are stable and enjoy coming for their monthly visit. I believe the face-to-face encounter is still very important and crucial to patient success.

Reimbursement issues (ie, lack of reimbursement) have been noted as an impediment to adoption of home dialysis. Has this been a problem for you and, if so, how have you been able to manage such a large home dialysis population from a financial perspective?

Dr Gupta: Reimbursement issues can be a hurdle when first starting. The dialysis companies have to dedicate a nurse to the program, and these programs can take a few years to mature. There are some positive reimbursements in terms of training of the patients that go to the dialysis center, and there are training payments that go the physicians as well. Ultimately, the reimbursements are good and when computed in a payment for time spent, they are fair.

Do you make house calls?

Dr Gupta: I do not do house calls, but our nurses do in-home visits to assess the environments and often check on patients on their own. I would welcome the chance to do them, but have not yet.

Do you think the COVID-19 pandemic will accelerate adoption of home dialysis nationally?

Dr Gupta: COVID-19 provides a unique opportunity to further interest and choice in home dialysis options. Patients are rightfully worried about being in environments where there are chances of exposure to COVID-19 and other communicable diseases. Home dialysis eliminates this possibility, and the current COVID-19 crisis is making patients realize this. I have found that patients are much more open to listening to these options now, and I have had some patients commit to conversion to peritoneal dialysis or home hemodialysis over the past few weeks. A strategy for home dialysis growth has always been to approach patients at moments when they are feeling stress about in-center therapies, and this is one of those moments.

Anthony DeCosta 5/5/20 Anthony DeCosta 5/5/20

Monogram Health Announces Series A-1 Funding to Further Kidney Health

The new round brings the total funds raised to $12 million in the past 15 months and reflects a growing national focus on kidney disease and at-home healthcare services

NASHVILLE, Tenn. — May 5, 2020 — Monogram Health, a leading kidney disease benefit management company, announced today that it has secured $7 million in funding through the closing of a Series A-1 financing round. The round was co-led by Frist Cressey Ventures and Norwest Venture Partners. The funding represents another significant milestone for

Monogram as the company continues to grow, increase health plan partnerships and manage the care of vulnerable patients with kidney disease through in-home engagement and increased interaction during this time of heightened isolation brought forth by the COVID-19 pandemic. Monogram currently operates its kidney disease benefit management programs for thousands of patients across the U.S., including Humana Medicare Advantage and Commercial plan members in Louisiana and Mississippi. The company partners with health plans to collaborate with nephrologists and ensure high quality patient care is delivered cost effectively. Monogram’s benefit management team of nurses, social workers, nephrologists, and geriatricians develop strong and lasting relationships with patients through in-person visits to their homes, inclusive of family members and community support, as a means of improving overall health outcomes. Through these regular visits, Monogram’s specialized care teams monitor and manage patients’ kidney care delivery, such as appropriate medication compliance, as well as transitions to and adherence with renal replacement, palliative care, and other evidence-based treatment modalities.

“We pride ourselves on working with innovative companies that are truly transforming the delivery of healthcare, and we share in Monogram’s vision of making kidney care more accessible to more people, lowering the cost of care, and at the same time improving their quality of life and health outcomes,” said Senator Bill Frist, M.D., Co-Founder & Partner of Frist Cressey Ventures and Monogram Health’s board chairman. “In light of the COVID-19 pandemic, the need for high-quality, in-home kidney health services are only growing, and Monogram is at the forefront of this shift to home-based benefit management and delivery.”

Home visits and frequent interaction with Monogram team members have become even more vital in light of COVID-19. These visits have been instrumental in safeguarding high-risk patients with serious underlying health conditions against unnecessary hospitalizations, missed physician visits and the emotional impacts of being isolated in a time of social distancing. Monogram supports the delivery of care in the home and outside of clinics and healthcare facilities, minimizing the potential spread of COVID-19. 2

“The COVID-19 pandemic has put a spotlight on the home as a safe healthcare setting for dialysis and other kidney-related care,” said Casper de Clercq, General Partner, Norwest Venture Partners. “Monogram’s solution empowers the vulnerable patients with renal disease to be seen in the comfort and safety of their own homes and to choose treatment modalities that are home-based, rather than clinic-based. This innovative approach to managing kidney care delivery will help improve health outcomes for a population that drastically needs and deserves better care.”

The funding also comes as the Centers for Medicare and Medicaid Services is increasing its attention and focus on the cost and quality of kidney care for its Medicare beneficiaries. Through the 21st Century Cures Act, Medicare beneficiaries with end stage renal disease will have the option during the Annual Election Period (AEP) later this year to enroll in 2021 Medicare Advantage plans administered by private health insurers to provide coverage for their care needs.

Anthony DeCosta 5/5/20 Anthony DeCosta 5/5/20

NBJ Exclusive: Frist-founded Healthcare Startup Raises $7 million

Monogram Health is gearing up for a period of rapid growth in part because of the enactment of the 21st Century Cures Act, which will allow Medicare beneficiaries with end-stage renal disease to enroll in 2021 Medicare Advantage plans through private insurers for the first time. See the full story here.

Anthony DeCosta 5/5/20 Anthony DeCosta 5/5/20

Yahoo Finance Shares Coverage on Recent Series A-1 Funding Round

May 5, 2020 – The funding represents another significant milestone for Monogram as the company continues to grow, increase health plan partnerships and manage the care of vulnerable patients with kidney disease through in-home engagement and increased interaction during this time of heightened isolation brought forth by the COVID-19 pandemic.

Read below or click here to read on Yahoo!

The new round brings the total funds raised to $12 million in the past 15 months and reflects a growing national focus on kidney disease and at-home healthcare services.

Monogram Health, a leading kidney disease benefit management company, announced today that it has secured $7 million in funding through the closing of a Series A-1 financing round. The round was co-led by Frist Cressey Ventures and Norwest Venture Partners. The funding represents another significant milestone for Monogram as the company continues to grow, increase health plan partnerships and manage the care of vulnerable patients with kidney disease through in-home engagement and increased interaction during this time of heightened isolation brought forth by the COVID-19 pandemic.

Monogram currently operates its kidney disease benefit management programs for thousands of patients across the U.S., including Humana Medicare Advantage and Commercial plan members in Louisiana and Mississippi. The company partners with health plans to collaborate with nephrologists and ensure high-quality patient care is delivered cost effectively. Monogram’s benefit management team of nurses, social workers, nephrologists, and geriatricians develop strong and lasting relationships with patients through in-person visits to their homes, inclusive of family members and community support, as a means of improving overall health outcomes. Through these regular visits, Monogram’s specialized care teams monitor and manage patients’ kidney care delivery, such as appropriate medication compliance, as well as transitions to and adherence with renal replacement, palliative care, and other evidence-based treatment modalities.

"We pride ourselves on working with innovative companies that are truly transforming the delivery of healthcare, and we share in Monogram’s vision of making kidney care more accessible to more people, lowering the cost of care, and at the same time improving their quality of life and health outcomes," said Senator Bill Frist, M.D., Co-Founder & Partner of Frist Cressey Ventures and Monogram Health’s board chairman. "In light of the COVID-19 pandemic, the need for high-quality, in-home kidney health services are only growing, and Monogram is at the forefront of this shift to home-based benefit management and delivery."

"The COVID-19 pandemic has put a spotlight on the home as a safe healthcare setting for dialysis and other kidney-related care," said Casper de Clercq, General Partner, Norwest Venture Partners. "Monogram’s solution empowers the vulnerable patients with renal disease to be seen in the comfort and safety of their own homes and to choose treatment modalities that are home-based, rather than clinic-based. This innovative approach to managing kidney care delivery will help improve health outcomes for a population that drastically needs and deserves better care."

About Monogram Health

View source version on businesswire.com: https://www.businesswire.com/news/home/20200505005231/en/

Contacts

Sheila Biggs
312.837.3458
sbiggs@jarrardinc.com

Anthony DeCosta 12/19/19 Anthony DeCosta 12/19/19

Monogram Health and Humana Sign Care Coordination Agreement For Chronic Kidney Disease Patients in Louisiana and Mississippi

NASHVILLE, Tenn. — December 19, 2019 — Monogram Health and leading health and wellness company Humana Inc. (NYSE: HUM) have signed an agreement for Monogram Health to provide coordinated care services for Humana Medicare Advantage and Commercial health plan members in Louisiana and Mississippi with chronic kidney disease (CKD) and end-stage renal disease (ESRD).

The agreement aligns with the companies’ mutual goal to help improve the physical and emotional health and well-being of patients by working to delay the progression of CKD and ESRD; better the patient’s quality of life; and, when applicable, leverage the benefits of in-home therapies.

“Monogram is honored to collaborate with a leading health and well-being company such as Humana,” said Senator Bill Frist, M.D., Monogram Health’s board chairman. “Partnerships like this represent the future of healthcare and bring great potential to further improve the quality of care, system integration, as well as patient outcomes and well-being.”

Monogram’s benefit management staff consists of nurse case managers and social workers who regularly visit CKD and ESRD patients in their homes, whether in urban or rural communities. Monogram support staff work with the patient’s nephrologist and primary care physician to ensure that each patient develops a thorough understanding of his or her disease and receives a personalized care plan. Monogram also seeks to improve medication and treatment compliance and to ensure appropriate bio-metric monitoring, nutrition planning and adherence, and effective consideration of each patient’s social determinants of health through all facets of care delivery.

Humana Medicare Advantage and Commercial members with CKD and ESRD will have 24/7 access to Monogram’s support team; and access to Monogram Health’s at-home renal benefit management program, which offers services that include home visits by nurse-led benefit management teams.

“Through this collaboration, we will strengthen care coordination for Humana members with kidney disease. Our partnership will offer customized care options and will empower patients with education and engagement tools to better manage their condition,” said William Shrank, MD, MPHS, Humana’s Chief Medical and Corporate Affairs Officer. “This multidisciplinary approach will focus on detecting kidney disease earlier, slowing disease progression, and utilizing therapies that enable members to receive care in the convenience of their own home.”

The agreement between Monogram and Humana comes after the issuance of a federal executive order that seeks to transform kidney care in the United States by creating provider payment models that reward kidney care specialists for achieving high-quality patient outcomes and cost efficiency. According to the United States Renal Data System (“USRDS”) the Medicare program spends approximately $114 billion annually for beneficiaries with CKD or ESRD. However, according to the Center for Disease Control (“CDC”), it is estimated that 48% of those with severely reduced kidney function and not on dialysis are unaware they have kidney disease, because the disease progresses before symptoms are first experienced. An estimated one-third of those who experience kidney failure had never seen a nephrologist prior to the occurrence of the clinical event.

“Our sole focus on CKD and ESRD, combined with expertise in advanced payment models, allows us to partner with health plans and providers across the spectrum of healthcare delivery,” said Dr. Raymond Hakim, Monogram’s Chief Medical Officer. “We are pleased to help Humana’s members determine the optimal modality and setting for their care.”

Individuals with CKD and ESRD cannot properly filter blood, causing waste and fluid levels that can endanger their health. Effective management of the disease requires coordinated management of health services and patient engagement in their care.

Additional Information
The Provider may contract with other plans.

Anthony DeCosta 12/11/19 Anthony DeCosta 12/11/19

Humana Announces New Care Coordination Services for Members With Kidney Disease

Designed To Improve the Patient Experience and Health Outcomes, Services to be Available Initially in Four States

LOUISVILLE, KY--(BUSINESS WIRE)--Leading health and well-being company Humana Incopens new window. (NYSE: HUM) is expanding its care management portfolio by teaming up with two specialized care management companies to offer personalized, coordinated services for Humana Medicare Advantage and Commercial members with kidney disease who live in four states. Through agreements with Monogram Health and Somatus, Humana will offer care coordination to better diagnose and manage kidney disease toward improving members’ quality of life and their health.

Individuals with chronic kidney disease (CKD) cannot properly filter blood, causing waste and fluid levels that can be dangerously high. According to the Centers for Disease Control, CKD affects more than 30 million Americans – many of whom are not aware of their condition - and is the nation’s ninth-leading cause of death. Management of CKD is complex, and failure to appropriately manage the condition may cause worsening health outcomes and considerable symptoms for those with CKD.

“Through this collaboration, we will strengthen care coordination for Humana members with kidney disease. Our partnerships will offer customized care options, and will empower patients with education and engagement tools to better manage their condition,” said William Shrank, MD, MPHS, Humana’s Chief Medical and Corporate Affairs Officer. “This multidisciplinary approach will focus on detecting kidney disease earlier, slowing disease progression, and utilizing therapies that enable members to receive care in the convenience of their own home.”

Teams from the two companies consist of clinicians – including nephrologists, nurses, dietitians, and social workers – who work to break down barriers to integrated kidney care. Services will include care coordination with a member’s primary care physician and nephrologist; in-home health and medication assessments; patient education about treatment options such as home dialysis; and emotional support through counseling.

Monogram Health and Somatus will serve eligible Humana Commercial and Medicare Advantage members as follows:

Monogram Health in Louisiana and Mississippi*
Somatus in Georgia and Virginia**

“Humana is pleased to be able to offer our members with chronic kidney and end-stage renal disease a range of specific care management services to meet their unique health needs and help them spend more time at home than at a clinical care facility,” said Susan Diamond, Humana’s Segment President, Home Business. “This is a holistic, comprehensive approach to care for members with late-stage kidney disease. Through these agreements, Humana is proud to deepen our longstanding commitment to improve the patient experience and health outcomes, while reducing the cost of care.”

* Services now available

** Services available starting January 1, 2020

About Humana
Humana Inc. is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.

To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools – such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions – combine to produce a simplified experience that makes health care easier to navigate and more effective.

More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com, including copies of:

Annual reports to stockholders
Securities and Exchange Commission filings
Most recent investor conference presentations
Quarterly earnings news releases and conference calls
Calendar of events
Corporate Governance information

Additional Information
Humana is a Medicare Advantage HMO and PPO organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. Other providers are available in our network. The provider may contract with other Plans.

Anthony DeCosta 7/11/19 Anthony DeCosta 7/11/19

Trump Administration Announces Kidney Care Demonstration

July 11, 2019 – Yesterday, President Trump and Health and Human Services Secretary Alex Azar made a significant policy announcement that will improve care quality for patients with Chronic Kidney and End Stage Renal Disease.

The President signed Executive Order on Advancing American Kidney Health, marking a move in the right direction for Kidney care and reflecting the foundational beliefs of Monogram Health. Sections 4 and 5 of the order provide 30 days for Secretary Azar to select payment models aligning financial and clinical outcomes for patients with CKD and ESRD. The executive order aligns with Monogram Health’s vision of:

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Like you, Monogram Health is committed to being a positive force for change in our industry and in patients’ lives. We are excited Secretary Azar has announced details of the chosen payment mechanisms so that we can move forward. Whether those details will be included in an extension of the current ESCO program, or part of a new program around CKD specifically, Monogram Health will be following up with you in the near future in order to facilitate participation in this groundbreaking initiative.

Our Board Chairman Senator Bill Frist, MD stated, “I applaud the focus of Health and Human Services to improve the care that patients living with Chronic Kidney Disease receive through the ‘Advancing American Kidney Health’ policy. Monogram Health is excited to partner with the nation’s leading nephrologists to improve kidney care delivery and the health outcomes achieved for those living with kidney disease.”

Anthony DeCosta 7/10/19 Anthony DeCosta 7/10/19

HHS Launches President Trump’s ‘Advancing American Kidney Health’ Initiative

July 10, 2019 – Today, President Donald Trump signed an Executive Order to launch Advancing American Kidney Health, a bold new initiative to improve the lives of Americans suffering from kidney disease, expand options for American patients, and reduce healthcare costs. The initiative provides specific solutions to deliver on three goals: fewer patients developing kidney failure, fewer Americans receiving dialysis in dialysis centers, and more kidneys available for transplant.

As directed by the Executive Order, the U.S. Department of Health and Human Services (HHS) announced today that the Centers for Medicare & Medicaid Services (CMS), through its Center for Medicare and Medicaid Innovation (CMMI), released a proposed required payment model and four optional payment models to adjust payment incentives to encourage preventative kidney care, home dialysis, and kidney transplants. The Department’s Assistant Secretary for Planning and Evaluation (ASPE) also released a paper entitled Advancing American Kidney Health, which lays out a number of areas for action, including measures called for in the executive order, for various components of HHS to improve kidney care.

Read the full article from HHS here.