‘Make care better, keep costs low’: Speaker discusses impact of nephrology payment models
Key takeaways:
- Fitting patient care into existing payment models can be complicated but possible.
- Synergy among health care professionals, including nephrologists and other physicians, is vital.
LAS VEGAS — There is a critical need for payment models that improve the quality of care for patients with kidney disease, while also curbing costs, according to a speaker here.
In a policy session at the Annual Dialysis Conference, Gaurav Jain, MD, associate professor of medicine in the division of nephrology and director of ambulatory nephrology at the University of Alabama Medicine at Birmingham and Healio | Nephrology News & Issues Editorial Advisory Board Member, covered benefits and complexities of implementing payment structures into practice.
“I spoke about alternative payment models in nephrology right now,” Jain told Healio after the presentation. Specifically, “lessons we learned from [the End-Stage Renal Disease Treatment Choices model], the transplant models and the multiple other Medicare Advantage [programs].”
Value-based care systems include mandatory programs such as the ESRD Treatment Choices (ETC) and Increasing Organ Transplant Access models. In addition, there are voluntary options, such as the Kidney Care First and Comprehensive Kidney Care Contracting models, plus managed care plans and incentive programs, according to Jain.
Fitting into any of these systems could get complicated, Jain said. Patients with kidney disease often present with multiple comorbid conditions that can make treatment costly and complex. CMS, in fact, recently ended the ETC model because data showed no benefits such as increased home dialysis use or transplant waitlisting.
The voluntary Kidney Care Choices model, meanwhile, faces challenges such as fewer participating entities post-COVID-19, according to Jain. Recent data show increased rates of home dialysis and better patient engagement, but no financial savings for Medicare with this model, raising questions about the sustainability of such programs, he said. Particularly, smaller practices could lack resources needed for value-based care initiatives.
Jain also discussed the Medicare Advantage landscape for patients on dialysis. Medicare Advantage has a high-cost population, he said, so there is an inherent interest in lowering expenses. Commercial plans may enhance patient care through coordinated efforts, but they could focus on profitability over outcomes and limit patient options.
Value-based care, while not perfect, may offer a solution since payers can have their own plans or partner with a health system, Jain said.
There is also “significant interest” from payers like CMS, he said.
With a more ideal payment structure, there can be a greater ability for patients to avoid unnecessary hospitalizations, Jain said, and clinicians may expedite care and referrals.
Jain said collaboration is important among health care providers, including nephrologists, primary care physicians and other specialists, to create a cohesive care network. Despite existing challenges, it is possible to improve care quality without substantially increasing costs while prioritizing patient care, fostering collaboration and ensuring that financial incentives align with positive health outcomes, he said.
It starts with a question: “How do we incorporate this into our practice, and how do we make care better and keep our costs low, remembering the patient always comes to first?”
For more information:
Gaurav Jain, MD, can be reached at gjain@uab.edu.
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Jain G. Moving beyond traditional payment models: Always patients first. Presented at: Annual Dialysis Conference; March 13-16, 2025; Las Vegas.
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