Clinical Programs - Chronic Kidney Condition Program

The Chronic Kidney Condition Program is designed to improve care for members with chronic kidney disease (CKD) and end stage renal disease (ESRD) by reducing hospitalizations and emergency room visits.

This program is available to Tufts Health Plan Commercial members who have been diagnosed with chronic kidney disease, stages 3 through 5. Members are identified through claims data or can be referred into the program by a care manager, a physician or by self-referral.

The goals of the program are to educate members about kidney disease as a complement to the provider’s plan of care, improve self-management, and facilitate care and services between the member, physicians, hospitals and other health care providers.

A registered nurse care manager with expertise in renal management works closely with the member and his or her family/caregivers to complement the member’s plan of care.

The Chronic Kidney Condition Management Program includes the following components:

  • Screening evaluation to determine appropriateness for the program
  • Telephone-based care management to coordinate and optimize care based on the stage of the member’s chronic kidney disease 
  • Physician contact and care plan updates
  • Assistance so members can understand their benefits and to provide referrals to other health programs as needed

Intervention support for members enrolled in this program includes the following:

  • Education about kidney disease
  • Guidance to improve self-management
  • Facilitated care during their treatment

Commercial members starting or receiving dialysis or anticipating kidney transplant have specific eligibility considerations related to the timing of Medicare becoming the primary payer and Tufts Health Plan becoming secondary payer.

Care Managers support commercial members for timely submission of Medicare application. USFHP members are eligible for Medicare at the start of dialysis.

To refer patients to the Chronic Kidney Condition program, please call the Tufts Health Priority Care line at 888.766.9818 ext. 53532.

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