From paid services to value-based care: results for kidney enhancement

The traditional fee-for-service (FFS) healthcare model is not suitable for meeting the complex needs of patients with chronic diseases, including chronic kidney disease (CKD). With the cost spiral and population health decline, Value-Based Care (VBC) proposes a solution that can reshape how health care systems can be managed using CKD and can serve as a model of how we treat other chronic diseases.

The nephrology field faces significant challenges, especially in increasing care costs for patients with multiple health conditions. Instead of meeting the needs of these long-term patients, the FFS model motivates the amount (rather than quality) of care given, resulting in frequent hospital visits and readmissions. VBC proposes an alternative approach that motivates providers to maintain patient health rather than responsively address complications after they occur.

The shift to preventive, coordinated care to preventive can help address physical and social factors that affect health outcomes, allowing nephrologists to work more effectively with their patients. Given the shortage of kidney experts and their many responsibilities in various healthcare facilities, value-based models can provide resources and support systems that enable efficient and effective chronic disease management.

Current Renal Care Landscape and Its Limitations

CKD affects more than 35 million Americans, accounting for more than 24% of the entire Medicare budget. In the FFS payment model, providers make money based on the services provided rather than the quality of the result achieved. This creates incentives that promote treatment of complications rather than stopping them. Since CKD patients are often required to rebound between different experts, repeated tests, conflicting treatments and missed opportunities for comprehensive care are common.

By linking incentives to patient outcomes, preventive services, and cost-effectiveness, adopting a VBC model can help address this systemic flaw. Rather than reward quantity, value and quality will be at the forefront. This shift will ultimately address the root cause of making the current model of kidney care both expensive and ineffective.

Separate management of conditions can lead to fragmented care that cannot meet the needs of patients, especially because these conditions are interrelated. Areas that are often overlooked are related to basic inequality, such as income, education, food security and transportation. These are all facilitators of the risk of early onset and faster progression of kidney disease, which further emphasizes the failure of isolated care methods.

Challenges to increase the nephrologist's workforce

Nephrology labor shortage is one of the biggest obstacles to providing more optimized renal care, as there are not enough experts to meet the needs. This shortage stems in part from geography, as newly trained nephrologists tend to tend to urban areas, while rural communities are underserved.

Medical students often lack exposure to outpatient kidney disease during training, as well as misunderstandings about management complexity, chronic illness and career prospects, including income opportunities and work-life balance, hinder the pursuit of professionalism.

These labor constraints require creative solutions and VCBs can play a role. In VBC, nephrologists are the leader in the multidisciplinary nursing team. These interdisciplinary teams (IDTs) include advanced practice providers, nurses, nutritionists, pharmacists and social workers, expanding the coverage and effectiveness of kidney physicians in providing comprehensive care. Technologies such as telemedicine can also bridge geographical shortages, bringing the expertise of experts and IDT to patients regardless of their location.

The VBC model can improve work-life balance, increase new income streams and reduce physician burnout. Kidney scientists can focus on preventing and building patient relationships, rather than agitation through high-volume appointments. As job satisfaction increases, you will be more interested in the students' kidney disease major.

Kidney care policy pattern

Healthcare funds shape how industry providers operate. The Centers for Medicare and Medicaid Services (CMS) shapes how the U.S. provides kidney care through payment policies, as more than 80% of residents with end-stage renal disease have traditional Medicare or Medicare Advantage insurance, and CKD has a disproportionate impact on older adults. The current FFS payment model adopted by CMS has led to a sharp increase in health care costs, especially in patients with complex chronic diseases such as CKD.

The Kidney Care Choice (KCC) model was created by Medicare and the Medicaid Innovation Center (CMMI) to transform the delivery of kidney care and demonstrate how policy changes can create incentives for better outcomes through controlled costs. From reducing progression to renal failure and increasing home treatment options to expanding opportunities for kidney transplants, the model reshapes the financial incentives for providers and encourages them to focus on helping patients live longer and healthier lives.

Early results in the KCC model were encouraging, showing significant improvements in patient outcomes. Many kidney care entities (KCEs) in the model are driving Medicare savings, but the impact on Medicare's overall cost is yet to be determined. CMMI recently announced that the Integrated Kidney Care Contract (CKCC) program in the KCC model will be extended until 2027 to continue to collect data on the overall program impact. As KCE continues to focus on health maintenance and prevention, hospitalization and other expensive overuse services are expected to decrease.

Realizing a value-based future

The future success of kidney disease care will depend on early detection and prevention strategies that can slow disease progression. This will require screening of high-risk populations when problems arise with screening for rapid intervention. Technology will also play an increasingly important role in this shift, with systems such as remote monitoring allowing continuous tracking of patients' health to avoid frequent office access and artificial intelligence, thereby identifying patients with the highest risk of complications. Both innovations can help achieve targeted interventions and prevent expensive emergencies.

Addressing health disparities must also be a priority, as kidney disease disproportionately affects certain populations. The VBC model will help because it incorporates social determinants of addressing health into treatment plans and generates incentives to improve outcomes for underserved populations.

Systematic changes from FFS to VBC will represent not only the payment model transition, but also the overall transition to patient-centric healthcare, which takes precedence over activities. Long-term success will require collaboration between policy makers, health care providers and patients, so kidney disease can create better results for coordinated preventive care while controlling costs.

Photo: Peterschreiber.media, Getty Images

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