Chronic kidney disease (CKD) is often referred to as a “silent killer” because many people who have it don’t exhibit symptoms until their condition becomes severe. Nearly half of the people who need a nephrologist don’t have one, and 40% of patients with severe (stage 4) or end-stage (stage 5) kidney disease have never seen a nephrologist in an outpatient setting.
In addition, caring for CKD patients is very complex because kidney disease is rarely the only diagnosis. Often, hypertension and diabetes are involved, frequently as a cause of kidney disease.
CKD takes its toll on the whole of our healthcare system. Medicare spends in excess of $130 billion – more than 24% of total spending – on patients with kidney disease while end-stage kidney disease (ESKD), which affects only 1% of Medicare beneficiaries, accounts for 7% of its spending.
This spending arises from the increasing incidence of CKD and the often very costly medical interventions associated and related to it, such as cardiovascular disease, dialysis and kidney transplantation.
Value-based care as the new imperative
Value-based care has emerged as an attractive and effective alternative to traditional fee-for-service approaches for payers and providers. The model aligns incentives with patient outcomes, improving the quality and delivery of care, while driving costs out of the system.
The many benefits of a value-based approach can clearly be seen in kidney care. Nephrology ranks second among medical specialties with high rates of adoption of value-based care, according to McKinsey & Company, and a recent analysis found value-based care better enables nephrologists to succeed in Centers for Medicare & Medicaid Services (CMS) and Medicare Advantage value-based programs.
Hospitalizations make up 40% of all payers’ costs for end-stage kidney disease (ESKD) patients, and 30% of costs are attributable to dialysis. For the entire CKD population, 30% of insurers’ costs are hospitalizations.
Value-based care’s “360-degree” support and services enable treatment of the whole person, not just the disease. With this approach, nephrologists prevent unnecessary hospital visits.
To accomplish this, nephrologists in value-based arrangements are using support and services such as nutritionists, behavioral health specialists, and pharmacists, along with providing social support such as transportation and assistance with meals. By focusing on reducing more drastic healthcare episodes and interventions in the future, the patient receives better care at a reduced cost.
Fewer hospitalizations and fewer readmissions lead to substantial savings and better quality of life.
Enabling VBC requires strategic partnership, data insights, and established network of providers
The benefits of value-based care models have been validated across a range of specialties. As a result, many providers and payers have joined the transition to fee-for-value. To meet that demand, a new generation of companies touting value-based care solutions has cropped up. All of them claim they can improve outcomes and decrease costs, but their capabilities and claims need to be carefully scrutinized.
Picking the right value-based partner can be the difference between succeeding and failing for payers and providers in a fee-for-value world. We know from our work in the nephrology space that it takes much more than a sales pitch and a promise to unlock the benefits of a value-based approach. It takes a commitment to the model and to the processes and tools it requires.
Interwell Health believes that you have to be all-in to make value-based care work. We take full risk for entire populations, making us responsible for their health and costs. We welcome patients who have never seen a nephrologist. We offer a nephrology-specific EHR that records all the data points required to care for a single patient, as well as an entire patient population. Interwell is everywhere the patient needs support, slowing disease progression. Drawing on our unmatched network, scale, experience and proven results, we partner with nephrologists and payers to help patients live longer, healthier lives.
About the author
Dr. George Hart is chief medical officer and David Pollack is president and chief operating officer at Interwell Health.
For more information, visit interwellhealth.com