Chronic kidney disease (CKD) affects more than 1 in 7 U.S. adults, while approximately 2 in 1,000 are living with end-stage kidney disease (ESKD)—kidney failure that is treated either with a kidney transplant or through dialysis. Today, however, there is much that can be done to prevent kidney failure if CKD is diagnosed early and comorbid conditions are well managed. Patients with CKD and ESKD have multiple complex chronic conditions, and ensuring optimal health requires whole person care. Kidney patients are on many medications, under the care of multiple providers, and frequently require emergency or inpatient hospital services. Helping people with kidney disease stay healthy requires education, care coordination, and other support as they navigate a complex health care system.
With such unique care goals and layered complexities in patients with kidney disease, nephrologists—kidney specialists—are uniquely positioned to lead the team. Value-based care (VBC), a health care model focused on increasing quality and lowering costs, gives patients access to the additional services and team members they need. VBC is reshaping specialty care by aligning incentives around prevention, improving outcomes for some of the most complex and chronically ill patients, and supporting physicians with the infrastructure needed to deliver proactive, team-based care.
It encourages continuity of care.
VBC promotes an integrated approach, encouraging collaboration across teams to deliver holistic care to address not just CKD, but a patient’s additional underlying comorbid conditions. Often, patients with CKD may be dealing with concerns like hypertension, diabetes, or cardiovascular disease, just to name a few. As a result, CKD patients see a variety of health care professionals to manage their care. This may include working with a dietician to regulate weight and glucose levels, a social worker to cope with the emotional toll of the disease, and a pharmacist to manage prescriptions.
Inter-professional teamwork among all of these providers results in better patient safety. Furthermore, close collaboration has been associated with fewer medical errors, reduced hospital readmissions, and improved patient outcomes. It’s crucial that those working with CKD patients communicate openly and embrace a team-based mentality to deliver the best possible care, and VBC helps to further encourage this behavior.
It drives long-term patient engagement.
When patients are active participants in their own care, they are more likely to adhere to their health plans. Feeling empowered motivates them to practice self-efficacy and adhere to treatment plans. People with CKD or ESKD will need to manage their condition for the rest of their lives, so encouraging long-term engagement empowers them to control their own care alongside the knowledge and guidance provided by health care providers, ultimately improving outcomes.
VBC is inherently patient-centric, driving providers to proactively engage, coupling treatment with education, which leads to better long-term outcomes. By prioritizing prevention through regular checkups, care screenings, and monitoring for complications, VBC can result in fewer hospitalizations, proactively addressing chronic conditions before they escalate further.
It supports equitable care delivery.
VBC models aim to treat each patient individually, addressing disparities in health care access and outcomes. Significant disparities among racial and ethnic minority groups exist within kidney care, leading to inconsistent outcomes. Individuals of African American, Hispanic, and Native American descent are disproportionally affected by CKD, partially due to the higher prevalence of diabetes and high blood pressure—the leading causes of CKD—within these populations. Compared to the 12 percent of White adults who have CKD, about 14 percent of Hispanic and 20 percent of Black adults have CKD. Meanwhile, Black, Hispanic, Asian, and Native American patients are more likely to be diagnosed with CKD after it has progressed into later stages of the disease when treatment options are more limited.
VBC addresses the underlying causes of these health care inequities, providing resources to impact social determinants of health and barriers common in marginalized populations. VBC models can help identify high-risk patients and tailor interventions accordingly.
Looking ahead: Building a sustainable future for chronic disease management
The prevalence of chronic disease in the U.S. has increased by 7 to 8 million people every 5 years within the last two decades, and the cost of chronic disease is estimated to reach $47 trillion worldwide by 2030. It’s imperative that the health care system embrace a more sustainable and effective approach to chronic disease management. A VBC payment model is uniquely designed to address the needs of chronic disease patients, where a disease like CKD along with several other underlying conditions must be managed simultaneously. VBC promotes personalized, coordinated care, leading providers to adopt an interdisciplinary approach that focuses on patient education and addresses health inequities. Instead of focusing on the quantity of services, VBC enables providers to prioritize the quality of overall patient care, leading to better chronic disease outcomes and better experiences for both patients and providers.
Timothy Pflederer is a nephrologist.
