How Value-Based Kidney Care Benefits Both Patients & Providers

Chronic kidney disease (CKD), damage to the kidneys which interferes with the organ’s ability to effectively filter blood, affects more than 1 in 7 U.S. adults, with as many as 9 in 10 unaware they even have the disease. Not only is CKD highly prevalent in the U.S., but it’s also very deadly. CKD is the eighth leading cause of death in the country, causing more deaths than breast cancer or prostate cancer each year. Yet, a shortage of nephrologists – doctors who specialize in kidney care – and a lack of patient awareness around CKD cause the disease to be an under-recognized public health crisis. 

Value-based care (VBC), healthcare designed to focus on care quality, provider performance, and patient experience, aims to improve CKD patient outcomes and delay disease progression. By personalizing treatment plans for each patient, nephrologists and the interdisciplinary team can address social determinants of health and shift care to the home setting, improving outcomes. With a focus on educating patients on the importance of treatment plan adherence and improving communication among providers, value-based care provides a payment model that supports services that are not covered by traditional fee-for-service and empowers nephrologists to implement best-in-class services.

Personalizing Patient Care to Improve Outcomes

VBC promotes health equity by addressing patients’ unique medical, behavioral, and social needs, focusing on educating patients regarding their personal risk factors and slowing disease progression. Social and economic factors play a major role in CKD. Disparities in access to healthcare, healthy food, transportation, and housing increase the likelihood of CKD in racial minorities and people facing economic disadvantages. 

For example, although Black and African Americans make up 13% of the U.S. population, they account for 30% of all patients with kidney failure. The increased prevalence of CKD among African Americans is in part due to higher rates of diabetes and hypertension, two major CKD risk factors, that exist within the community. A combination of genetics, prevalence of risk factors, socioeconomic effects, and healthcare discrimination lead to these disparities, those of which are reduced through value-based care’s focus on personalization of care and patient education. 

VBC also incentivizes the shift of care to the home setting which allows patients to maintain their regular routines and live life to its fullest. While 68% of patients with end-stage kidney disease are on dialysis, home dialysis allows for greater flexibility and freedom, reducing side effects and limiting the need to travel for care. Successful provider organizations that participate in VBC models, have shown to reduce hospitalizations by over 5% and lower emergency department visits by over 13%, improving patient outcomes and enabling patients to resume typical routines.

Recruiting New Nephrologists to Sustain Future Demands

The Association of American Medical Colleges (AAMC) estimates that non-primary care specialties, including nephrology, will experience a shortage of between 21,000 and 77,100 physicians by 2034. 

Nephrology is historically a lower paying medical subspecialty, treating very chronically ill patients. The complexity of the patient care involved requires interdisciplinary coordination, long and off-hour coverage, making nephrology a difficult specialty with sometimes little reward.

However, demands for more kidney care providers have increased as Type 2 diabetes, the leading cause of CKD, has increased by nearly 20% over the last decade. The second leading cause of CKD, hypertension, continues to increase in prevalence as the U.S. population ages, with the condition affecting more than 70% of adults ages 60 and older, adding to the urgency of filling these much-needed nephrologist positions.

VBC incentivizes communication among providers in the way of EHR and data sharing, encouraging those across care specialties to work together to achieve the best patient outcomes. Many nephrologists in private practice are siloed from providers at larger organizations or health systems. VBC improves interdisciplinary care coordination by taking a patient-centric approach, encouraging patients to get involved in decision-making and leading to higher treatment plan adherence rates. This coordination and participation address the isolation many nephrologists feel and lessens provider burnout and turnover.

On the business side, VBC payment models empower nephrologists with financial backing to implement best-in-class clinical programs. As opposed to a fee-for-service model where providers are paid for each procedure or medical visit, in a VBC model, nephrologists receive financial incentives for meeting quality care benchmarks, holding them accountable for improving patient outcomes. Nephrologists participating in VBC models are able to prioritize quality patient outcomes, leading to greater patient progress and, in turn, job satisfaction.

Currently, kidney disease treatment accounts for more than 24% of Medicare’s total spending. CKD also attributes to about 1.3 million deaths worldwide each year. Despite promising new research published on the significant impact medication treatments like GLP-1s and SGLT2 inhibitors have on slowing kidney disease progression, the extremely high costs of kidney care and staffing challenges require continued disruption of the status quo of healthcare delivery now. VBC models will help achieve improved patient care, address population health, and lower healthcare costs. It also provides a more sustainable approach to ensuring an adequate number of nephrologists can deliver high-quality kidney care, with a focus on early intervention to improve patient outcomes and slow disease progression.