Three companies, including CVS Health, discuss future of kidney care
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At the Renal Physicians Association annual meeting, representatives from three companies shared their approach to the changing paradigm of kidney care and emphasized the shift to value-based models that center on the patient.
Bruce Culleton, MD, vice president and chief medical officer for CVS Kidney Care (a subsidiary of CVS Health), began the discussion by describing the current system, one which he calls “fragmented,” noting it is primarily fee-for-service.
“It's a system where many of the payments coming from government, or coming from private plans, are fee-based or based upon the delivery of certain activities,” he said. “These incentives are frequently misaligned across the value chain and providers are paid for each service that is performed. The focus truly is on episodic problem-oriented care.”
According to Culleton, although there are challenges to making the shift to a value-based care system, he predicts it will occur within the next 5 to 10 years as regulation is being implemented to change the payment structure to dialysis providers and physicians.
“This type of system provides an opportunity to align incentives across the value chain, where providers are paid based upon their ability to drive better clinical outcomes for patients, as well as lower overall system costs,” he said.
CVS Kidney Care
CVS Kidney Care, Culleton said, supports this movement and is embracing not only the shift to value-based care, but to patient-centric or patient-enabling care.
He outlined a few areas where the company has contributed to this shift, including a kidney health services business which he said, “helps identify patients with kidney disease and provide flexible care management to delay onset of kidney failure, improve quality of life and reduce cost of care.”
CVS Pharmacies also now have HealthHubs and MinuteClinics, where patients can receive convenient walk-in care for a range of injuries, illnesses and exams.
Further, he said, more progress is being made on an integrated Renal Care Network, where services are provided to help practices develop home-based programs. Culleton emphasized that patient choice is central to the future of kidney care, and home dialysis (peritoneal dialysis, as well as hemodialysis) need to be available on a broader scale.
Cricket Health
The next panelist, Carmen Peralta, MD, CMO of Cricket Health, highlighted what she called the exciting and “transformative” nature of kidney care today.
She said that Cricket Health utilizes an evidence-based clinical model that rests on three primary pillars. The first is early detection and risk stratification, which she said is “one of the most important fundamental parts of restructuring kidney care.” The second is a multidisciplinary care which, according to Peralta, has been shown to improve outcomes and reduce costs.
“Then, the third pillar is about building the infrastructure to meet the patient where they are,” she said. “That means not only geographically, but also in their social and behavioral determinants in their lives. These all need to happen aligned in a value-based care system, where we pay for the outcomes that patients want to see and the outcomes that we as a system and as physicians want to see.”
Peralta addressed how Cricket Health is focused on improving the ways in which care is delivered. These include the utilization of predictive analytics to build a model that helps in earlier identification of patients who may have kidney disease or who are at high risk for adverse events, like hospitalizations.
“Together, that allows us to identify the patients that need the care,” she said.
Patients who need further care then join a program where they receive care from multidisciplinary teams that individualize treatments to patients’ goals. Patients can also use a platform for virtual discussions with physicians to gain further information on their disease or to join an online community.
“This has been an incredible opportunity for patients to form a sense of community and feel like they're not alone in going through this journey,” Peralta explained, adding that the model also supports home visits for high-risk patients.
“The most important thing here is that we have to align the incentives to make sure that we are getting paid for the outcomes that we want to see,” she said. “I believe that this change cannot happen with just one company or one particular model, but it needs the collaboration of the entire renal community and, in fact, the medical community in general, because PCPs have a very important part in the transformation of kidney care, especially since much of the early disease is seen in primary care practices.”
Strive Health
Lastly, Shika Pappoe, MD, CMO for Strive Health, touched on holistic care and leveraging technology to improve patient outcomes.
According to Pappoe, holistic care consists of many intersecting elements. These include developing interdisciplinary care teams that focus not only on clinical factors, but on non-clinical variants of care (such as social determinants of health and psychosocial issues).
“Probably most importantly, in holistic care, is the focus on forming strong and lasting relationships with our patients and their families, thereby rebuilding trust in the health care system.”
In addition, Pappoe emphasized building a dialysis infrastructure in which home modalities are more readily available and utilizing technology for virtual care, as well as predictive analytics and real-time alerts to provide proactive care.
“We have to support navigation of this complex kidney care ecosystem and be there with the patient at every single touchpoint within that ecosystem,” she said. “There has to be integration among the various providers, so that we are not working in silos. This will allow us to better align with the patient experience, which is the heart and soul of everything we do.”
All the panelists agreed that the Advancing American Kidney Health initiative and the COVID-19 pandemic have changed the course of how kidney disease will be managed in the future, with Peralta drawing parallels to the HIV epidemic.
“There was a lot of movement, and we got more funding and we moved a disease that was fatal to being a chronic disease in 2 decades,” she said. “I firmly believe that if we work together, we can make a change like that – a change where kidney disease doesn't look like this [in the future]. Let's not make it take 20 years. Let's make it a lot less than that.”
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Culleton B, Peralta C, and Pappoe S. Disruptive innovation. Presented at: RPA Annual Meeting. March 18-20, 2021 (virtual meeting).
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