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Speaker: Chronic kidney disease is ‘perfect’ disease for high-value care
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AUSTIN, Texas — In a move to high-value health care, nephrology providers will have to shift their focus from measurements based on process measures to those focused on patient health outcomes, according to the presenter of the keynote address here at the National Kidney Foundation Spring Clinical Meetings.
“While all of medicine is quite fragmented as we know, nephrology seems to be especially so,” Chris Moriates, MD, assistant dean for health care value and associate professor of internal medicine at the Dell Medical School at The University of Texas at Austin, said.
Moriates said studies have shown that one-third of patients who start hemodialysis (HD) have not seen a nephrologist until their presentation to the hospital to begin HD. Additionally, 50% of patients who start HD have not had care at all or have had care for less than 6 months by a nephrologist.
“It does make a difference,” he said, as the literature indicates a 25% reduction in first-year mortality when patients have a relationship with a nephrologist for at least 1 year prior to starting dialysis. Also concerning, he said, are published studies that show patients on dialysis have the highest out-of-pocket costs associated with their care of all Medicare patients, he said.
“That is the problem. We can do better,” he said.
Moriates said health care providers can do better by coordinating care, identifying patients earlier, getting patients the outcomes they deserve and looking out for their financial well-being. The model that achieves this, he said, is value-based health care, which is defined as outcomes that matter to patients divided by the total costs of care.
“I am not here advocating for cheap health care. I don’t want cheap health care; you don’t want cheap health care ... We want something that is safe; something that is a good experience and not to be gauged for it. That is not often something we deliver in health care,” he said.
Value depends on context, he said. Health care professionals need to think about health care like they think of everything else – that is “When is it worth it?”
One way to start to get there is to measure what matters and focus on outcomes – and not all outcomes, he said. Value-based health care coordinates care around the needs of patients and the patient experience, he said. In making the leap from the current health care system to value-based health care, he said the focus will need to move to patient health outcomes. Additionally, the actual costs of providing patient care will be measured and captured, and team-based care interactions will be organized around patient medical needs and conditions.
“[Chronic kidney disease] CKD is the perfect disease for high-value care. CKD is, as we know, a continuum – it is chronic; it is progressing,” he said.
It is also ideal for longitudinally based, team-based care across the continuum, and health care professional also can identify and deploy resources for patients who need it. – by Kristine Houck, MA, ELS
Reference:
Moriates C. Working together to deliver high-value care. Presented at: National Kidney Foundation Spring Clinical Meetings; April 10-14, 2018; Austin, Texas.
Disclosure: Moriates reports he receives royalties from McGraw-Hill and grant support from ABIM Foundation, Macy Foundation, Episcopal Health Foundation and the Accreditation Council for Graduate Medical Education.