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Review
. 2021 Aug 16;2(10):1677-1683.
doi: 10.34067/KID.0004552021. eCollection 2021 Oct 28.

Value-Based Care in Nephrology: The Kidney Care Choices Model and Other Reforms

Gaurav Jain  1 , Daniel E Weiner  2
Affiliations
Review

Value-Based Care in Nephrology: The Kidney Care Choices Model and Other Reforms

Gaurav Jain et al. Kidney360. .

Abstract

The Advancing American Kidney Health (AAKH) initiative has reinvigorated the focus on improving the care of patients with advanced CKD. Multiple interventions have been planned, focusing on education campaigns for both clinicians and patients, delaying the progression of kidney disease and improving utilization of home dialysis modalities and kidney transplantation. Value-based care models for patients with advanced kidney disease are being rolled out, with the ESKD treatment choices model starting in January 2021, and the Kidney Care Choices model planned to start in January 2022. There is increasing emphasis on the role of the nephrologist as the "captain of the ship," leading efforts in care coordination as physician leaders. The transplant reforms have focused on changes to organ procurement organizations aiming to increase availability of organs, and transplants performed, both deceased and living donor, and removing financial disincentives from live organ donation. The American Society of Nephrology (ASN) and the National Kidney Foundation (NKF) are partnering with the Department of Health and Human Services to develop educational material for clinicians and patients. In this review, we discuss these reforms, potential challenges that have arisen, and potential solutions, with emphasis on the Kidney Care Choices model.

Keywords: ETC; KCC; chronic kidney disease; clinical nephrology; dialysis; kidney care choices; patient activation measure; value-based care.

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Conflict of interest statement

D.E. Weiner reports consultancy agreements by participating in Medical Advisory Boards for Akebia (2020, 2021), Cara Therapeutics (2020), Janssen Biopharmaceuticals (2019), and Tricida (2019); reports receiving honoraria for Akebia paid to Dialysis Clinic, Inc. (DCI); reports receiving research funding with all compensation paid to AstraZeneca (site principal investigator [PI], completed 2020), CSL Behring (site PI, ongoing), Goldfinch Bio (site PI, ongoing), Janssen Biopharmaceuticals (site PI, completed 2019), Tufts MC: DCI (site PI for trials contracted with DCI including Ardelyx, ongoing, and Cara Therapeutics, completed); reports receiving honoraria from the NKF for editorial positions at Kidney Medicine and the American Journal of Kidney Disease, Elsevier for royalties from the NKF's Primer on Kidney Diseases; and reports being a scientific advisor or member of as Co-Editor-in-Chief, NKF Primer on Kidney Diseases, 8th Edition, Editor-in-Chief, Kidney Medicine, Medical Director of Clinical Research, DCI, Member, ASN Quality and Policy Committees and ASN representative to Kidney Care Partners, Scientific Advisory Board, NKF Other Interests/Relationships, Chair, adjudications committee, Evaluation of Effect of TRC101 in Progression of CKD in Subjects with Metabolic Acidosis (VALOR-CKD Trial, George Institute, Clinical Research Organization, sponsored by Tricida), and Member, Data Monitoring Committee, “Feasibility of Hemodialysis with GARNET? in Chronic Hemodialysis Patients with a Bloodstream Infection” Trial (Avania Clinical Research Organization). All remaining authors have nothing to disclose.

Figures

Figure 1.
Figure 1.
AAKHI: Multipronged approach to kidney care. OPO, organ procurement organization; HRSA, Health Resources and Services Administration; NKF, National Kidney Foundation; ASN, American Society of Nephrology; AAKHI, Advancing American Kidney Health Initiative; ETC, ESKD treatment.
Figure 2.
Figure 2.
Details of the Kidney Care Choices model. *KCF model only; **CKCC model only; ***Home Dialysis True-Up: US$35 per patient per month for patients on home dialysis. KCF, Kidney Care First; CKCC, Comprehensive Kidney Care Contracting.
Figure 3.
Figure 3.
Kidney Care Choices: Lessons learned before model implementation.
See this image and copyright information in PMC

References

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