Healthmap’s Kidney Health Management (KHM) program is an end-to-end population health management solution for people with chronic kidney disease (CKD) and end-stage renal disease (ESRD). It is designed to identify kidney disease and rising risk earlier, slow disease progression, close gaps in care, support appropriate transitions when disease advances, and improve outcomes while reducing avoidable healthcare utilization and costs.

Healthmap’s Kidney Health Management (KHM) program supports people across the kidney disease journey—from earlier-stage chronic kidney disease (CKD) through advanced CKD and end-stage renal disease (ESRD). Healthmap typically manages members with CKD stages 3, 4, and 5, unspecified CKD, and ESRD across Medicare Advantage, Medicaid, and Commercial populations. The program is particularly valuable for members who have rising clinical risk, gaps in care, multiple chronic conditions, recent hospitalizations, or complex medical and social needs.

Healthmap combines available healthcare data, predictive analytics, and clinical expertise to identify kidney disease and rising risk earlier, prioritize each member’s most important care opportunities, and connect those insights to timely action by members, providers, and Healthmap’s care team. Importantly, identifying risk is not the endpoint. Healthmap connects those insights to provider collaboration, member outreach, Care Navigation, education, medication support, and other interventions intended to close care gaps and address risk before kidney disease progresses or an avoidable acute-care event occurs.

Yes. Healthmap supports transitions of care with coordinated post-discharge outreach designed to improve continuity and reduce avoidable readmissions. Support can include timely member outreach after discharge, medication reconciliation, PCP and specialist follow-up, identification of clinical and social barriers, and multidisciplinary care coordination. For higher-risk members, Healthmap can also provide additional support such as home visits where available.

Yes. Healthmap works alongside existing care teams, supporting rather than replacing them. Healthmap reinforces providers’ treatment plans with patient-specific insights, proactive member outreach, and Care Navigation that extends support between visits. It also shares timely information on risk, care gaps, transitions, and opportunities for follow-through so providers and care teams can take action when needed.