Value-Based Care and Kidney Disease: Emergence and Future Opportunities

  • Sri Lekha Tummalapalli
    Address correspondence to Sri Lekha Tummalapalli, MD, MBA, MAS, Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, 402 East 67th Street, New York, NY 10065.
    Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY

    The Rogosin Institute, NY, NY
    Search for articles by this author
  • Mallika L. Mendu
    Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

    Center for Population Health, Mass General Brigham, Boston, MA
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      The United States health care system has increasingly embraced value-based programs that reward improved outcomes and lower costs. Health care value, defined as quality per unit cost, was a major goal of the 2010 Patient Protection and Affordable Care Act amid high and rising US health care expenditures. Many early value-based programs were specifically designed for patients with end-stage renal disease (ESRD) and targeted toward dialysis facilities, including the ESRD Prospective Payment System, ESRD Quality Incentive Program, and ESRD Seamless Care Organizations. While a great deal of attention has been paid to these ESRD-focused programs, other value-based programs targeted toward hospitals and health systems may also affect the quality and costs of care for a broader population of patients with kidney disease. Value-based care for kidney disease is increasingly relevant in light of the Advancing American Kidney Health initiative, which introduces new value-based payment models: the mandatory ESRD Treatment Choices Model in 2021 and voluntary Kidney Care Choices Model in 2022. In this review article, we summarize the emergence and impact of value-based programs on the quality and costs of kidney care, with a focus on federal programs. Key opportunities in value-based kidney care include shifting the focus toward chronic kidney disease, enhancing population health management capabilities, improving quality measurement, and leveraging programs to advance health equity.

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