Misha Palecek, Chief Transformation Officer, DaVita Kidney Care
Two small, bean-shaped organs have tremendous power—both in our bodies and the larger U.S. health care system.
Chronic kidney disease (CKD) affects approximately 1 in 7 (37 million) U.S. adults. Unfortunately, 90% of people with CKD don’t know their kidney function is declining. 1
With limitations to identifying CKD early and treating disease progression, 50% of people diagnosed with kidney failure “crash” into dialysis—starting treatment without warning in an emergency situation.2 Crashing not only causes physical and emotional shock for patients but also it costs, on average, an additional $53,000 per patient in the first year of dialysis treatment.3
This adds financial burden to an already costly patient population. Medicare spends nearly $120 billion a year on patients with kidney disease, with costs focused on management of multiple comorbidities, hospitalizations, life-sustaining dialysis treatments and kidney transplantation.4
Kidney patients deserve better. The building momentum to shift kidney care from fee-for-service to value-based care offers the best opportunity for change.
Value-based kidney care
Value-based care economically motivates providers and physicians to improve outcomes while lowering the total cost of care. It has worked particularly well in high-cost, high-need patient populations, such as those with CKD and kidney failure.5
In kidney care, value-based care creates an opportunity to help patients with CKD manage their kidney health. It empowers physicians and care teams to prevent or delay kidney disease progression by better managing risk factors like diabetes and hypertension.
For individuals whose kidneys fail, value-based care better positions nephrologists to provide early modality education, helping patients transition to the right treatment at the right time, whether that’s pursuing a preemptive kidney transplant or receiving dialysis at home or in an outpatient center.
Unifying patients’ kidney care journey
Today’s fragmented care system has created care silos separating early-stage CKD and kidney failure. These two conditions are inextricably tied to one another and should be integrated—clinically and financially—through value-based care to reward better health across the entire kidney care journey. This would incentivize providers to contain care costs for either patients with manageable kidney disease or those with kidney failure.
It’s highly effective for providers to collaborate with transformation-driven nephrologists to share financial accountability for the complete patient journey. Established providers and nephrologists have been doing this with payor partners and within government pilot programs for more than a decade. In fact, as an early adopter of value-based care arrangements, DaVita has driven better health outcomes at lower costs across all stages of CKD through kidney failure.
Why hold providers accountable for the health they help create rather than the services they provide? It rewards patient engagement, prevention, improved outcomes and lower costs across all stages of kidney disease, having a positive impact on individual patient care and population health.
In areas like Minnesota, local area nephrologists (in partnership with DaVita) are now collaborating with payors to care for the holistic kidney health needs of members. DaVita Integrated Kidney Care is working alongside the primary care community to reach patients earlier by offering kidney disease screenings and proactive management of risk factors like diabetes and hypertension. Further, DaVita is supporting patients who have kidney failure with multidisciplinary care teams to better meet their complex kidney and non-kidney care needs.
It’s logical—and better for patient care—to realign kidney care in this way and connect patients with resources across the health care community. Providers with scale have existing relationships, finely-tuned operations and partnerships with nephrologists to help rapidly transform kidney care in the U.S.
It’s time to leave behind transactional care that treats early-stage CKD and kidney failure disjointedly. Working seamlessly along the care continuum is one way we can improve kidney care—helping patients enjoy better kidney health outcomes while reducing costs to the U.S. health care system.
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1 According to the Centers for Disease Control and Prevention (CDC) Chronic Kidney Disease Fact Sheet, 2019.
2 Risk Factors for Unplanned Dialysis Initiation: A Systematic Review of the Literature (2019) https://journals.sagepub.com/doi/full/10.1177/2054358119831684#_i42
3 2009–2012 Medicare 5% sample data weighted average across all states for patient costs in first twelve months of dialysis.
4 USRDS Annual Data Report 2020, Figures 9.8, 6.1; 2018
5 Roer, D., Fukui, M., Smith, N., Nissenson, A., & Becker, B. (2019). The American Journal of Accountable Care. Current Value-Based Care Models Need Greater Emphasis on Specialty Care, 7(3). https://doi.org/10.37765/ajac
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