Value-based healthcare (VBHC) is one of the most important topics being explored in healthcare transformation today. This strategy aims to maximize patient value by achieving the best outcomes possible at the lowest cost.
Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) have complex needs that are costly since they require high-quality, coordinated care. Historically, models of care for CKD and ESKD patients have been fragmented, placing a substantial economic burden on healthcare systems. Value-based kidney care models based on VBHC were introduced to reduce healthcare costs and improve patient outcomes by incentivizing physicians and care providers.
- Value-based kidney care reduces the rising costs of CKD and ESKD and improves patient outcomes.
- Value-based kidney care models provide patients with coordinated care, reduced costs, holistic care, and empowerment.
- Critical opportunities identified in value-based kidney care include enhancing CKD and ESRD population health management, leveraging programs to improve health equity, and enhancing quality measurement.
What is value-based kidney care?
Due to unsustainable healthcare expenditures, especially as related to chronic diseases in the U.S, the concept of value-based healthcare (VBHC) has been explored in depth for the CKD care area. VBHC, based on the research of Professor Michael Porter, is a framework for restructuring healthcare systems with the overarching goal of value for patients.
According to Professor Michael Porter, “value” can be measured using evidence-based approaches and is defined as patient-relevant outcomes over costs per patient. The patient-relevant outcomes for chronic kidney disease patients can be defined into four specific areas:
- Patient-recorded health and well-being
- Treatment specific outcomes
- Burden of care
Thus, the value-based approach aims to pay providers for the outcome of the patient, not for the services they provide the patient.
The evolution of value-based kidney care
The standard of care for patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) has long been the ‘fee-for-service’ model. However, the ‘fee-for-service’ model proved to be more expensive as certain behavior patterns emerged, such as lack of accountability, high utilization, and siloed care management.
Three years after the implementation of the Affordable Care Act 2012, value-based kidney care was introduced. An ‘ACO’-like model called Comprehensive End-Stage Renal Disease Care (CEC) Model was the first value-based kidney care model launched by the Centers for Medicare and Medicaid Services (CMS). The CEC model aimed to better coordinate ESKD spending and care. This program was the first step in encouraging more holistic kidney care. However, it was only centered around dialysis providers and not nephrologists.
The CMS improved the CEC model and, in 2022, introduced an improved value-based kidney care model, Kidney Care Choices (KCC). This model is a nephrologist-led care model that expands beyond ESKD patients also to include CKD patients. The KCC model is structured to help healthcare providers improve the quality of care and reduce the cost for patients with late-stage CKD and ESKD. This model also reduces or delays the need for dialysis and encourages kidney transplantation.
KCC addresses some of the historic misalignment in kidney care reimbursement by emphasizing CKD management, leveling payments across dialysis modalities, encouraging kidney transplants, and providing incentives for investments in interdisciplinary care teams.
The KCC model includes four options:
- CMS Kidney Care First (KCF) Option
- Comprehensive Kidney Care Contracting (CKCC) Graduated Option
- Comprehensive Kidney Care Contracting (CKCC) Professional Option
- Comprehensive Kidney Care Contracting (CKCC) Global Option
- Increased access to care, physicians and experts.
- Data shows that physician-led organizations significantly outperform organizations led by other providers.
- Cost of care reduction.
- Leveraging partnerships from other specialties to help manage patients’ other underlying medical conditions and comorbidities.
- Reduction in hospitalization rates.
- Expanded coordination between different specialties and departments.
- Patient education to manage disease progression and avoid complications.
- Support programs are always in place.
- There is a need for the use of data and technology by a kidney care provider to manage CKD and ESKD patients more holistically.
- New incentives will lead to novel investments, such as developing risk capitalization, interdisciplinary care teams, and analytical assets.
Four ways patients can benefit from value-based kidney care:
1. Coordinated Care
Value-based kidney care models work to build/leverage relationships between patients and their specialist care teams across multiple disciplines. Patients can benefit from coordinated care when their nephrologist, pharmacist, and other healthcare members collaborate to manage all aspects of CKD or ESKD.
Thus, coordinated care ensures that CKD patients can receive the most appropriate care for their individual needs.
2. Patient Empowerment and Satisfaction
In value-based kidney care models, patients are encouraged to play a more active role in their care. This is implemented through increased patient engagement and better communication between patients and providers. Patients are also empowered to be involved in making decisions regarding their treatment journey.
New healthcare technologies, such as telemedicine, help providers to focus on education and keep patients informed throughout their care journey.
3. Reduced Costs
Value-based care aims to create a funding structure to invest in care coordination technologies or strategies that improve patient outcomes. This ultimately reduces the total cost of care.
In value-based kidney care programs, the providers are responsible for the patient’s overall care. As a result, it is important to leverage partnerships to help provide patients with holistic care. Leveraging partnerships often eliminates or reduces avoidable hospital or emergency room trips. In the value-based care model, the providers share the cost savings from reduced hospitalizations. These funds, for example, can be reinvested into care coordination solutions.
Patients can experience cost reductions from:
- Better management of CKD progression, late-stage CKD, and ESKD
- Reduced hospitalizations
- Individualized treatment plans based on their stage and risk profile
4. Better Health
Patients may receive better overall health outcomes as physicians and providers are incentivized to improve the quality of patient care. In a value-based model, providers play an active role in patient care and outcomes, which has markedly improved overall patient health.
Health benefits for patients in value-based kidney care:
- Increased planned dialysis starts
- Focused preemptive care
- Individualized treatment plans with regular check-ups
- Increased access to a team of experts and care physicians
- Support programs
- Reduction in hospitalization rates as patients are treated as outpatients
How Panoramic Health delivers value-based kidney care
At Panoramic Health, we are a physician-led organization, which uniquely positions us to understand both the patient’s and provider’s needs. We provide a transformative approach to kidney care delivery as we partner with providers, practices, and health systems to advance patient care. We deliver compassionate and personalized care for all patients across the CKD spectrum via holistic interventions.
Panoramic Health provides a comprehensive care model by leveraging clinical and operational data to create patient-centric population health initiatives that are individualized to each practice’s specific care-delivery process. This comprehensive care model provides longitudinal care to each patient, including individualized interventions to better manage acute events.
Panoramic Health value-based kidney care by the numbers:
- $872 average pmpm savings
- 800+ providers
- 930+ partner dialysis centers and hospitals
- 65% patient engagement
- 56% reduction in hospital readmissions
- 30% at-home dialysis starts
- 54% improvement in planned dialysis starts
Patients are empowered through omnichannel patient engagement, which provides them with comprehensive access to in-home, in-facility, and in-clinic care. The seamless integration of Panoramic Health’s comprehensive care model provides patients with a frictionless experience throughout their CKD or ESRD journey.
Panoramic Health provides value-based care opportunities by offering:
- Differentiated holistic care model with proven clinical outcomes
- Industry-leading multi channel patient engagement across all touchpoints
- Unparalleled data integration and analytics engine for advanced risk stratification and predictive modeling that helps identify at-risk patients earlier.
- Deep provider alignment with scalable delivery models that can integrate into practices as needed.