Polychronic Care Provider Raises $375 Million in Growth Funding

Monogram Health employs more than 1,000 clinicians and operates in 34 states.

Monogram Health, a polychronic care provider that specializes in home-based treatment of chronic kidney and end-stage renal disease, has raised $375 million in growth funding.

In chronic kidney disease, the kidneys are damaged and have a compromised ability to filter blood, according to the Centers for Disease Control and Prevention (CDC). About 37 million adult Americans have chronic kidney disease, the CDC says. In end-stage renal disease, chronic kidney disease advances to the point of kidney failure, according to Mayo Clinic. In 2019, treating Medicare beneficiaries with end-stage renal disease cost $37.3 billion, the CDC says.

In addition to treating chronic kidney and end-stage renal disease, Monogram Health treats all related conditions, Michael Uchrin, MBA, CEO and co-founder of the company, told HealthLeaders. "To go upstream and effectively treat chronic kidney disease, you have got to stabilize patients' blood pressure. You have got to stabilize their diabetes. You have got to get cardiovascular and pulmonary issues stabilized. We have gotten good at providing care for those other conditions."

The Brentwood, Tennessee-based company, which was founded in 2018, operates in 34 states and employs more than 1,000 clinicians, he says. "Our nationally scaled nephrology practice is akin to a multispecialty practice. We have nephrologists, who are kidney specialists, but we also have endocrinologists, cardiologists, and palliative care specialists. Many of our patients have end-stage comorbidities, and they do better on palliative care rather than dialysis. We also have internists who develop personalized treatment plans for each of our patients and oversee our nurse practitioners. So, each patient has an interdisciplinary care team of clinicians based upon their conditions."

Monogram Health also employs registered nurses, social workers, pharmacists, and care management teams. Utilization management teams focus on hospitalizations and discharge management.

Several organizations contributed to the $375 million growth funding, including CVS Health, Cigna Ventures, Humana, Memorial Hermann Health System, TPG Capital, Frist Cressey Ventures, Heritage Group, Pura Vida Investments, and Norwest Venture Partners.

The growth funding will be used to expand the company and invest in technology, Uchrin says. "Most of the growth funding that the company will utilize will go to continue the widespread deployment of our clinical programs. We will continue to build out our clinical infrastructure and workforce as well as continue to invest in technology. We are big believers in technology to enable our care delivery and deliver more effective care at the right place and right time. We are going to continue to improve our analytics and our artificial intelligence as well as the systems that our clinicians use, including the electronic health record our physicians and nurse practitioners utilize."

Clinical care model

Home care is an essential element of Monogram Health's care model, he says. "We are big believers in providing care in the home, especially for individuals as sick as our patient population. More than 90% of our visits are in the home, with the rest of the visits conducted via telehealth. Whether it is our nurse practitioners or even our care managers such as RNs and social workers, they are all engaging our patients in their communities. First and foremost, our care model enables better access to care. In many underserved communities, we are creating access where other specialists did not have brick and mortar facilities."

Monogram Health treats a range of comorbidities, Uchrin says. "We take a whole person, polychronic view of the treatment plan. We do not silo kidney care from cardiovascular disease or pulmonary disease—we treat the patient. On average, prior to coming to Monogram, one of our patients had seen seven specialists, which exacerbates fractured care. Our patients can just work with Monogram, whether it is kidney, cardiovascular, or any other condition—they know they can trust Monogram."

Providing polychronic care distinguishes Monogram Health from most home health providers, he says. "Rather than focusing on one specific need, we act as an individual's physician to treat all of their needs. Home health may come to the home for a six-week, finite episode of care to treat a wound. We are much more longitudinal. Not only do we treat the patient directly and handle all of their conditions, but we also manage their care across the healthcare delivery continuum. So, if an individual does need home health such as IV antibiotics, we will engage a home health provider and oversee the care to ensure that the treatment works as expected."

Financial model and partners

Monogram Health's financial model is focused on providing value-based care, Uchrin says. "We have a value-based care delivery economic model, where we partner with health plans and other risk-bearing entities such as forward-leaning health systems. We work with health plans to assume full medical-expense risk. We offer access and better affordability. We charge a fee for our services that is based on per-member-per-month fees on populations, and the value we create is better affordability around the total cost of care for the populations we have taken responsibility to treat."

The company works predominantly with Medicare Advantage health plans, but it has other partners as well, he says. "Medicare Advantage payers have leaned into our solution, and we have tremendous relationships with Cigna as well as Humana. We also work with forward-leaning health systems, including AdventHealth and Banner Health. We work with health systems that have value-based care relationships with their payer partners. We partner with those health systems to provide treatment for their chronic kidney and end-stage renal disease patients. We help to improve access to care, boost outcomes, and increase affordability."

Related: Technology Partnership Aims to Improve Kidney Disease Treatment