Multiple forces at the level of public health policy, legislative action and private-sector innovation have converged to accelerate the pace of change in the CKD space today compared to the relative lack of attention that has defined the past several decades.
The Centers for Medicare & Medicaid Services (CMS) are pushing for better models of kidney care that include a focus on CKD, demonstrating the agency’s acknowledgment of deficiencies in the current system and its commitment to driving improvements at the policy level. Key programs were announced in 2019, with target implementation by 2022:
- The Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) models will increase incentives for CKD management activities that delay progression to ESRD and incentivize kidney transplants; these programs will also introduce VBC incentives for clinicians that may include opportunities for clinicians to take on financial risk for late-stage patients
- ESRD Treatment Choices (ETC) will adjust CMS payments to clinicians and ESRD facilities to promote dialysis at home, which is made more feasible by the holistic care incentives introduced in KCF and CKCC
Recent legislative action is also having an impact. The 21st Century Cures Act, passed in 2016, enables ESRD patients to switch from traditional Medicare coverage to Medicare Advantage (MA), thus pushing MA plans to seek VBC solutions to manage the anticipated influx of costly ESRD members.
Further, an executive order (Advancing American Kidney Health) was issued in 2019, which created incentives for providers to delay patient progression to ESRD as well as improve diagnosis and surveillance efforts for early-stage CKD. It also established ambitious goals around the promotion of dialysis at home and increasing access to kidney transplants, both of which are expected to help reduce lifetime ESRD costs.
The combination of new government programs, the increasing relevance of MA and the development of new VBC solutions represents a major change in the healthcare industry, which now has significant incentives to delay the progression to ESRD by better managing CKD patients. Collectively, these recent changes have formed a catalyst for action in the private sector, where several secular trends are also contributing to improvements in the management of CKD and ESRD patients.
- Commercial and MA payers are embracing VBC and shifting their strategies to include more financial risk sharing
- The emergence of better data analytics tools has significantly increased the ability to mine patient and claims data for clinically relevant information (e.g., clinical decision support, better risk stratification, missed diagnoses)
- The proliferation of better care management models is increasing the capability of payers and risk-bearing provider groups to influence outcomes through better patient engagement and improved care coordination among disparate clinical stakeholders