With an estimated 37 million Americans affected by chronic kidney disease, Medicare launched the Comprehensive Kidney Care Contract (CKCC) model, which underscores the importance of proactive, coordinated kidney care.
Nephrologists are at the heart of this new model, and we need to work together to do more than just fix a broken kidney care delivery system. We must also advocate for an integrated ecosystem, the byproduct of which will be an engaged, motivated and empowered patient population.
The CKCC encourages nephrologists to delay the progression of kidney disease to kidney failure. It encourages people to switch to home-based renal replacement therapy, preemptive transplants and to start dialysis in an outpatient setting. If providers can band together to proactively manage renal treatment and patient comorbidities, an integrated care delivery ecosystem will emerge.
In developing this model, CMS analyzed comorbidities and concluded that all disease components were modifiable. Therefore, it is critical for the practice of nephrology to start taking this patient-centred approach and not just consider immediate kidney problems.
To be effective, we need to communicate and coordinate care with the entire team involved in patient care. Controlling comorbidities has a major impact not only on a patient’s overall health, but also on delaying the progression of kidney disease. While nephrology practices won’t completely move away from fee-for-service for the foreseeable future, it would be a win-win if we could start to gradually incorporate more value with volume-based initiatives.
Key considerations for CKCC success include:
- upstream intervention. By managing potential risks earlier and more proactively, we can help prevent many of the further health problems and unnecessary complications in people with CKD and end-stage renal disease.
- Access real-time data and analytics. If providers have access to real-time data, we can see important warning signs, whether it’s an irregular heartbeat, fluid retention, or a myriad of other symptoms. Seeing these conditions can significantly impact a patient’s future health and treatment.
- Multi-dimensional practical resources. From a nephrology practice perspective, we often don’t have access to the resources we need to be successful beyond just a fee-for-service. It can be helpful to work with companies that understand the kidney field and can provide an interdisciplinary clinical care team that acts as an extension of the nephrologist’s office. It is also important to partner with companies that can effectively streamline management processes, provide management expertise, and provide unique technical resources to help ensure success in the new model.
- Integrated Care Ecosystem. If nephrologists want to win the war, not just fight, we need to communicate consistently throughout the care process. PCPs play a vital role in this integrated care ecosystem as they are often the gatekeepers to our patients. We must also utilize all resources at our disposal, including but not limited to discharge planners, nurse practitioners, physician assistants, and nutritionists, so that we can facilitate the right care at the right time to prevent patients from ending up back in the hospital. Working with a PCP and using these dedicated care navigation resources is the only way we can dismantle the broken kidney care system.
While these considerations will help us succeed in CKCC, we need to think more deeply outside the scope of healthcare services.
Transforming kidney care in 2022 and beyond requires us to:
- go further upstream Prevent and delay kidney disease. Ideally, I would like to see us start identifying potential adverse events early in Phase 3.
- Investment awareness. By investing in awareness across the healthcare ecosystem, we can ensure earlier referrals and specialist intervention. Another important component is educating the public. About 35% to 40% of patients did not receive any kidney care before starting dialysis. By raising awareness of the importance of kidney health, we can try to prevent hospitalizations and disease progression.
- Incentivize health systems. When people are brought into the ER, how do we coordinate with the system to get patients into the ER? If a patient is being discharged, how do we coordinate with skilled nursing facilities to ensure a normal recovery? Many touchpoints in the care continuum are isolated and, as a result, patient recovery suffers.
- Strengthen remote monitoring. If a patient’s vital signs could be continuously monitored outside a doctor’s office, it could give doctors a more complete picture of an individual’s health than taking a single reading while in a doctor’s office.
- Move more care to more accessible homes. Today, most patients can access healthcare services with the click of an app. Therefore, healthcare systems should be willing to provide care, such as home dialysis, where patients are. Why do people with CKD have to arrange transportation with an outside company to make weekly dialysis appointments in town? Barriers such as these prevent patients from getting the care they need and deserve.
The CKCC model is a huge step towards delivering the right care to patients at the right time and place. As an industry, we must work together to ensure this model is successful, and we need to continue to reform the infrastructure to transform kidney care.
The statements contained in this document are solely those of the author and do not necessarily reflect the views or policies of CMS. The author accepts responsibility for the accuracy and completeness of the information contained in this document.
Photo: peterschreiber.media, Getty Images
