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

  • Sri Lekha Tummalapalli
    Correspondence
    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.
    Affiliations
    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
    Affiliations
    Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

    Center for Population Health, Mass General Brigham, Boston, MA
    Search for articles by this author
      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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