Introduction

This page describes how we use the Health Care Cost Institute (HCCI) commercial claims and Medicare and Medicaid data from CMS to construct the metrics contained in the Chronic Kidney Disease (CKD) dashboard.

Methods

The data underlying this dashboard is compiled from four administrative datasets: the HCCI Employer Sponsored Insurance (ESI) claims dataset¹, the Medicare Fee-For-Service (FFS) Research-Identifiable File (RIF) dataset, the Medicare Advantage (MA) Encounter dataset, and the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) RIF dataset. Note that not all datasets are available for all services.

Eligibility and Enrollment

All demographic information was collected from the respective payer enrollment and eligibility files. For all services, we limited our sample to enrollees with a known age and sex who were fully enrolled and eligible to receive services without restrictions during the calendar year. We mapped the Minority Health Social Vulnerability Index (MH-SVI) 5-digit zip codes from the eligibility and enrollment data.

ESI

We included members enrolled in EPO, HMO, POS or PPO plans. For outcomes related to medications, we only included members if they were enrolled in a plan with pharmacy benefits. For all other outcomes, all members were included independent of their pharmacy benefits. We limited the ESI sample to those under the age of 65.

Medicare

Medicare beneficiaries were included only if they were eligible for both Medicare Part A and Medicare Part B; beneficiaries were categorized as Medicare Advantage enrollees they elected enrollment as such. For pharmacy services, beneficiaries were only included if they were enrolled in a Medicare Part D plan. We limited the Medicare sample to those over age 17 and under the age of 85. Enrollees who were dually enrolled in Medicare and Medicaid were included in the Medicare group.

Medicaid

We limited this analysis to beneficiaries with complete enrollment records (i.e., non-missing eligibility information) who were not enrolled in a program with restricted benefits (e.g., we excluded beneficiaries enrolled in pediatric wrap- 2 around dental benefit program) and who were enrolled for the entirety of the month. Note that we may exclude some states’ data if we determine the data to be poor or incomplete based on internal and external benchmarks. We exclude beneficiaries who have enrollment records in more than one state.

Exclusions

We excluded patients with a pregnancy diagnosis² or evidence of hospice³ in the same calendar year as the disease diagnosis.

Total Enrollee Population by Payer

Year	ESI	Medicare Advantage	Traditional Medicare	Medicaid
2016	25,645,075	15,071,529	29,318,607	23,510,629
2017	25,600,729	16,302,664	29,299,850	24,561,763
2018	25,151,381	17,595,201	29,068,688	22,761,538
2019	25,528,507	19,436,766	28,870,115	23,869,133
2020	25,075,867	21,230,917	27,723,142	29,394,436
2021	21,895,865	23,483,550	26,461,803	37,599,726
2022	20,219,016		25,455,597	43,110,932

Variable Definitions

For all definitions, unless otherwise noted, we looked at diagnosis codes in any position on any claim line. Our counts are the number of unique enrollees using patient ID numbers per calendar year. See downloadable code list for complete list of codes.

Diseases

Chronic Kidney Disease: Member has at least two outpatient/professional claims or one inpatient claim within calendar year. See downloadable code list for diagnosis codes.

CKD Stage: Of those diagnosed with CKD, use highest stage for the calendar year to apply CKD Stage.

• N18.1: Stage 1
• N18.2: Stage 2
• N18.3: Stage 3
• N18.30: Stage 3
• N18.31: Stage 3
• N18.32: Stage 3
• N18.4: Stage 4
• N18.5: Stage 5
• N18.6: End stage renal disease (ESRD)
• N18.9: Unspecified

Acute Kidney Failure: Member has at least one claim with acute kidney failure diagnosis within the calendar year. https://hcup-us.ahrq.gov/toolssoftware/ccsr/ccs_refined.jsp

Hypertension: Member has at least two outpatient (OP)/professional claims or 1 inpatient claim with hypertension diagnosis within calendar year. https://www2.ccwdata.org/web/guest/home/

Diabetes: Member has at least two OP/professional claims or 1 inpatient claim with type 2 diabetes diagnosis within calendar year. https://www2.ccwdata.org/web/guest/conditioncategories-chronic

Anemia: Member has at least two OP/professional claims or 1 inpatient claim with anemia diagnosis within calendar year. https://www2.ccwdata.org/web/guest/home/

Cardiovascular disease: Member has at least two OP/professional claims or 1 inpatient claim with cardiovascular disease diagnosis within calendar year. See downloadable code list for diagnosis codes.

Hyperlipidemia: Member has at least two OP/professional claims or 1 inpatient claim with hyperlipidemia diagnosis within calendar year. https://www2.ccwdata.org/web/guest/home/

Obesity: Member has at least one claim with obesity diagnosis within calendar year. https://hcup-us.ahrq.gov/toolssoftware/ccsr/ccs_refined.jsp

Quality Indicators

Tests (uACR, eGFR, Cystatin-C, Point of Care uACR, Renal Biopsy): Member has at least one claim with that test in the calendar year. See downloadable code list for codes.

Note: To be counted as a uACR test, member must have both CPT codes 82043 and 82570 appear on the same day or within one day.

Medications (ACE/ARB, Statin, GLP1 inhibitor, MRA, SGLT2, NSAID): Member has at least prescription for that medication filled in the calendar year. See downloadable code list for a list of NDCs.

Hospitalizations: Member has at least one overnight stay in an inpatient facility.

Analysis

Measures are displayed in percents.
Percent = numerator / denominator*100

Footnotes

1. The data behind these estimates came from a national, multipayer, commercial health care claims database containing information provided by three data contributors – Aetna, Humana, and Blue Health Intelligence
2. If member had at least one pregnancy diagnosis during the calendar year using the pregnancy codes in the Clinical Classifications Software Refined (CCSR)
3. Using procedure and revenue codes from the Johns Hopkins HEDIS®: General Guidelines and Measure Descriptions