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Chronic Kidney Disease (CKD) Program

The Geisinger Health Plan Care Coordination CKD Program is based on the 2002 National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification.

The following is a description of the CKD program and its elements.

Program Goals and Strategies

The primary goals of the CKD Program are to: 1) identify members with CKD and assist you and the member with their care and (2) coordinate appropriate services for members with GFR < 30 mg/dl with participating nephrologists through the following:

  1. Incorporation of the K/DOQI Clinical Practice Guideline into a comprehensive health management program.
  2. Assessment of glomerular filtration rate (GFR) to identify level of kidney function

Interventions

Care Coordination nurses work with health care providers and rely on the following interventions when working with Health Plan members enrolled in the CKD program:

  1. Self-management education
  2. Evaluation and management of co-morbid conditions
  3. Evaluation and management of risk factors related to cardiovascular disease
  4. Evaluation and treatment of complications associated with decreased kidney function, which may include anemia, bone loss, uremia, and fluid management
  5. Coordination of dialysis or transplantation services when indicated
  6. Data analysis to support clinical management–GFR, renal ultrasound, anemia management, etc.

Program Referral

To refer a Health Plan member to the CKD program, please call (800) 883-6355 or (570) 271-6776 Monday through Friday, 8 a.m. to 4:30 p.m.

References

2002 National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification.