How to make sure Medicare’s kidney care contracting mannequin succeeds and transforms therapy

With an estimated 37 million People affected by persistent kidney illness, Medicare has launched the Complete Kidney Care Contracting (CKCC) mannequin, spotlighting the significance of proactive, coordinated kidney care.

Nephrologists are on the heart of this new mannequin, and we have to work collectively to do greater than restore a damaged kidney care supply system. We should additionally advocate for an built-in ecosystem, the byproduct of which shall be an engaged, motivated and empowered affected person inhabitants.

CKCC encourages nephrologists to delay the development of kidney illness to kidney failure. It incentivizes a shift in the direction of home-based renal substitute therapies, pre-emptive transplantations and beginning dialysis in an outpatient setting. If suppliers can crew as much as proactively handle renal therapies in addition to affected person comorbidities, an built-in care supply ecosystem will emerge.

In growing this mannequin, CMS analyzed comorbidities and concluded that every one the illness parts are modifiable. Subsequently, it’s important for nephrology practices to begin incorporating this patient-centric method and think about extra than simply rapid kidney considerations.

To be efficient, we have to talk and coordinate care with the whole crew concerned in a affected person’s care. Getting comorbidities underneath management has a big influence not solely on a affected person’s total well being but in addition in delaying the development of kidney illness. Whereas nephrology practices is not going to transfer utterly away from fee-for-service for the foreseeable future, if we are able to begin steadily incorporating extra worth versus volume-based initiatives, it’s a win-win.

The important thing issues for CKCC to succeed embody:

• Upstream intervention. By managing potential dangers earlier and extra proactively, we might help forestall a number of the well being points and pointless issues that emerge additional down the road for sufferers with CKD and end-stage kidney illness.
• Entry to real-time knowledge and analytics. If suppliers have the flexibility to entry real-time knowledge, we are able to see important warning indicators, whether or not it’s an irregular heartbeat, fluid retention or a myriad of different signs. Seeing these as they occur can considerably influence the long run well-being and therapy of a affected person.
• Multi-dimensional observe assets. From a nephrology observe standpoint, we regularly don’t have entry to the required assets to succeed and transfer past simply fee-for-service. It may be useful to associate with corporations that perceive the renal area, and which might supply a interdisciplinary scientific care crew that serves as an extension of the nephrologist’s workplace. It’s additionally essential to associate with corporations that may effectively streamline administrative processes, present administration experience and supply distinctive know-how assets to assist guarantee success inside the new mannequin.
• Built-in care ecosystem. If nephrologists need to win the struggle and never simply the battle, we have to talk constantly all through the whole care continuum. PCPs play a vital function on this built-in care ecosystem since they’re typically the gatekeepers to our sufferers. We should additionally use all of the assets obtainable to us, together with however not restricted to discharge planners, nurse practitioners, doctor assistants and dietitians so we are able to facilitate the precise care on the proper time to forestall sufferers from ending up again within the hospital. Working alongside PCPs and utilizing these devoted care navigation assets is the one means we are able to dismantle the fragmented kidney care system.

Whereas these issues will assist us succeed with CKCC, we should be pondering even additional outdoors the healthcare supply field.

Reworking kidney care in 2022 and past requires us to:

1. Go even additional upstream to forestall and delay kidney illness. Ideally, I want to see us begin figuring out potential adversarial occasions sooner in stage 3.
2. Put money into consciousness. By investing in consciousness throughout the healthcare ecosystem, we are able to guarantee earlier referrals and specialist intervention. One other essential part is educating the general public. About 35 to 40% of sufferers haven’t had any nephrology care previous to beginning dialysis. By rising consciousness across the significance of kidney well being, we are able to attempt to forestall hospitalizations and illness development.
3. Incentivize well being methods. When individuals are admitted to the ER, how will we coordinate with that system to get a affected person into an acute care clinic? If a affected person is being discharged, how will we coordinate with a talented nursing facility to make sure correct restoration? So many touchpoints within the care continuum are siloed, and because of this, the affected person’s restoration suffers.
4. Bolster distant monitoring. If sufferers’ vitals might be monitored repeatedly outdoors of the physician’s workplace, it may give the doctor a extra full image of a person’s well being, versus getting one studying whereas they’re within the physician’s workplace.
5. Transfer extra care into the house, the place it’s extra accessible. Nearly all of sufferers can entry healthcare via the press of an app nowadays. So the healthcare system must be keen to supply care the place the affected person is, similar to residence dialysis. Why ought to somebody with CKD have to rearrange transportation companies with an outdoor firm simply to have the ability to get to their weekly dialysis appointment throughout city? Roadblocks similar to these forestall sufferers from getting the care they want and deserve.

The CKCC mannequin is a superb step towards delivering the precise care on the proper time and place for sufferers. As an business, we should work collectively to make sure this mannequin succeeds and we have to proceed to overtake the infrastructure to rework kidney care.

The statements contained on this doc are solely these of the authors and don’t essentially mirror the views or insurance policies of CMS. The authors assume accountability for the accuracy and completeness of the data contained on this doc.

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