Presidential Order Ushers in National Kidney Health Initiative
Yesterday, the White House celebrated the signing of an Executive Order to launch Advancing American Kidney Health, a new initiative to improve the lives of Americans suffering from kidney disease, expand options for American patients, and reduce health care costs.
“The Advancing American Kidney Health is the biggest transformation of kidney policy since the Medicare End-Stage Renal Disease (ESRD) benefit 46 years ago, and aims to improve coordination of care, facilitate patient-centered care, stem progression of chronic kidney disease, increase transplantation and improve clinical outcomes while reducing costs,” says Dr. Mallika Mendu, Associate Medical Director at Partners Population Health for Specialty Programs and practicing nephrologist at Brigham and Women’s Hospital.
“It has been a privilege to be part of the American Society of Nephrology Quality Committee that has collaborated with other nephrology and patient advocacy organizations to offer guidance to Health and Human Services on their bold vision to transform kidney care,” she says.
Chronic kidney disease (CKD) affects over 25 million adults in the United States. As the disease progresses, kidneys are less able to filter wastes and excess fluids from the blood, which means dangerous levels of fluid, electrolytes, and wastes can build up in the body. Once the kidneys have reached this point, called End-Stage Renal Disease or ESRD, patients must receive dialysis for the rest of their life or receive a kidney transplant. In 2017, kidney disease was the ninth leading cause of death in the United States.
The Executive Order takes vital steps to increase the supply of available kidney transplants and aims to dramatically improve prevention and treatment, while making life “better and longer” for millions of Americans. The initiative provides specific solutions to deliver on three goals: fewer patients developing kidney failure, fewer Americans receiving dialysis in dialysis centers, and more kidneys available for transplant.
Nancy Scott, a former dialysis patient and kidney transplant recipient who spoke at the signing of the Executive Order said, “I am optimistically hopeful that the dialysis polices being proposed will help dialysis patients and their families navigate the renal care system with less confusion and more ease.”
The Executive Order also calls for Health and Human Services to:
- Launch a public awareness campaign to increase knowledge of chronic kidney disease.
- Reform the organ procurement and management system in the United States to significantly increase the supply of transplantable kidneys.
- Expand support for living donors through compensation for costs such as lost wages and child care expenses.
- Encourage development of wearable or implantable artificial kidneys.
This week, Health and Human Services is taking a number of immediate actions toward these goals. To reduce the development of end-stage renal disease, the Center for Medicare and Medicaid Innovation (CMMI) released a set of four optional payment models that give providers new incentives for preventing kidney disease and managing kidney patients’ health in a more comprehensive and patient-centered way. CMMI also released a required payment model involving providers and dialysis units to provide more options, including home dialysis, for people with kidney failure. All five new payment models will give providers new incentives to help eligible patients receive transplants.
“Improving health outcomes for those living with chronic kidney disease will be bolstered by the value-based incentives included in these new CMMI models,” said Dr. Sree Chaguturu, Chief of Population Health at Partners HealthCare. “Aligning patient-centric care options like home-based dialysis to appropriate financial and quality incentives allows us to better address the unique needs of this complex population.”
Partners Population Health has been involved in advancing kidney care for some time. The High-Risk Care Management Program for End-Stage Renal Disease (ESRD) works to provide care coordination to high-risk patients with ESRD. The goal of the program is to provide team-based, specialized services—led by a nurse care manager—to help patients navigate the system, prevent complications from worsening, and avoid hospitalization. The team has also developed an ESRD Registry to help identify care gaps across the spectrum of chronic kidney disease care, inform clinical quality improvement, and enable population health strategy implementation.
“Nephrologists across Partners HealthCare have embraced the concepts behind this vision for the past decade and are well positioned to act on the proposal,” says Dr. Mendu. “This is an historic moment for patients with kidney disease in the country.”