"I got this project started a few months ago," Masia said. "What I quickly found is that there really haven't been a lot of great estimates that employers can use to prioritize these early investments in CKD. It's well understood that it's a big problem, but what's less understood is how big the opportunity is. And what kind of return on investment you might be able expect, depending on the population of the employer."

Typical union plans and government employer plans tend to have especially big problems with severe kidney disease and especially big opportunities to improve kidney care, Masia said.

Kidney disease basics: Most people have two kidneys.

Kidneys are organs about the size of an orange that filter waste products from the blood, regulate mineral levels in the blood, regulate blood pressure and help keep the bones healthy

Doctors classify people as having chronic kidney disease when their kidneys do a poor job of filtering the blood for at least three months, according to a Midwest Business Group on Health fact sheet included in the webinar packet.

Common causes of chronic kidney disease include high blood pressure, diabetes, obesity, heart disease, genetic conditions and autoimmune disorders.

Kidney disease demographics: About 11 million of the 150 million now in the workforce, or 7.4% of the total, have kidney disease, Masia said.

Many people with Stage 1 or Stage 2 kidney disease have no symptoms, don't know that they have kidney disease and get no treatment for their kidney probles.

Stage 3 kidney disease affects 1.6 million workers and adds $54,939 in costs per plan participant per year.

Stage 4 kidney disease affects 174,000 workers and adds $71,010 in per costs per participant per year.

Stage 5 kidney disease affects 126,000 plan participants and adds $71,532 in costs per participant per year.

People with Stage 6 kidney disease have "end-stage" disease. They need to undergo kidney dialysis, or filtering, or get a kidney transplant to stay alive.

The number of Americans with "end-stage renal disease" increased to 816,000 in 2022, from 429,000 in 2002, according to the National Alliance.

For a U.S. employer plan, a kidney transplant costs an average of $446,800, according to Milliman.

High-risk groups: Employees and other plan participants who are obese, who have high blood pressure or who have diabetes are especially likely to suffer from kidney disease.

More than 30% of plan members with Type 2 diabetes have chronic kidney disease, according to Cheryl Larson, president of the Midwest Business Group on Health.

When Larson showed that kind of data to employers, and showed the employers how much cheaper testing for early-stage kidney disease was than treating severe kidney disease, "there was a lot of 'aha!' in this this employer group," Larson said. "This significantly increased their desire to promote early diagnosis and treatment."

What employers can do: Andy Baskin, a former Aetna national medical director, said employers can help reduce the odds that workers will develop severe kidney disease by providing a wide range of standard preventive care benefits.

Some of the simpler strategies include offering:

◆ Strong smoking cessation benefits.

◆ Strong weight control benefits.

◆ Access to standard medications for controlling diabetes and high blood pressure.

Statins "are certainly very inexpensive," Baskin said. "They can be no-cost-share if you like."

More expensive kidney disease control strategies include offering a high level of access to more expensive drugs, such as the SGLT2i blood sugar control drugs and GLP-1 agonists for weight loss and blood sugar control.

"The prices can be in the $600 per month range," Baskin said. "The GLP-1s, we've all heard, are in that $1,000 per month range."

Plans might consider making even those very expensive drugs available to the highest-risking patients with no cost sharing, to maximize adhere, Baskin said.