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As the global incidence of kidney disease rises, the burden on the world's healthcare economies continues to grow. Unsustainable healthcare spending will result in government policy shifts in the kidney disease space to address patient needs (Figure 2). As an example, in the biggest US policy change since the 1972 Social Security Amendments that extended Medicare coverage to kidney failure patients regardless of age, the July 2019 presidential executive order announcing the Advancing American Kidney Health initiative pledges to address the impact of kidney disease by reducing end stage kidney disease, slowing CKD progression, increasing kidney transplants and focusing on home dialysis care.
FIGURE 2 | Four factors impacting global kidney disease care
BUILDING A GLOBAL COMMON GROUND: HARMONIZING VALUES AROUND KIDNEY CARE
In 2019, Fresenius Medical Care's Global Chief Executive Officer Rice Powell announced the creation of the Global Medical Office as a key strategy to address kidney disease-related challenges of the global healthcare system. The Global Medical Office is charged with transforming care against the backdrop of an alarming worldwide public health epidemic, stressed ministries of health, radically diverse global regulatory frameworks, and unsustainable conditions in healthcare economies. This endeavor begins with finding common ground across global diversity.
Fresenius Medical Care concentrates on four distinct areas of harmonization:
1. Treating the full spectrum of chronic kidney disease (CKD)
A full, contextual view of CKD is required to bring solutions that address the global epidemic and to develop effective risk and care coordination strategies. It is necessary to consider the spectrum of stages 1-5 CKD, end stage renal disease (ESRD), and related comorbidities such as diabetes, hypertension, and cardiovascular disease (Figure 3).
FIGURE 3 | The CKD spectrum and related comorbidities
2. Slowing CKD progression
The global epidemic of kidney disease requires more than care interventions for patients in the final stages of illness. Fresenius Medical Care looks beyond ESRD to include the full range of complications that comprise CKD, focusing on efforts to slow disease progression through early detection, intervention, and addressing social determinants of health.
3. Coordinating patient-centered lifetime care
Fresenius Medical Care is pioneering the concept of life span care coordination by considering the full patient care journey in the context of the full CKD spectrum and by considering both power and choice as key drivers of patient outcomes and experience. Priorities include identifying opportunities for improvement in local access to care and delivering evidence-based standards of care (Figure 4).
FIGURE 4 | Patient care and modalities change with health circumstances and seasons of life
4. Protecting cardiac and vascular systems in CKD care
Cardiovascular disease is the leading cause of death for late-stage and end stage CKD patients. To minimize the chance of persistent or chronic injury to the cardiac and vascular systems during treatment, Fresenius Medical Care is focused on innovations, care coordination, and new technology that improves patients' ability to receive treatments in a way that protects their cardiac and vascular systems.
Collectively, these values of kidney care provide a framework for powerful global CKD care delivery and improved patient outcomes and experiences. Harmonizing these values globally leverages local insights toward a greater good.
GLOBAL COLLABORATION: IDENTIFYING TRANSFORMATIVE INNOVATIONS
At the core, kidney disease care innovation relies on collaboration to foster an environment of change and progress. Innovation must advance medical science and translate that new science into daily patient care. This opportunity to bring emerging science into standard patient care is a unique, inherent value of a vertically integrated company whose domain includes science, product development, manufacturing, service provision, provider partnership, and insurance (Figure 5).
FIGURE 5 | Examples of innovations being explored by Fresenius Medical Care
Delivering global innovations begins with generating ideas that lead to care delivery action. Key attributes of this innovative spirit include:
- Using interconnected intelligence for diverse idea generation
- Creating actions to follow commitment
- Focusing on innovations with high utility
- Being open to ideas and skills from inside and outside the corporate ecosystem
- Innovating for the future state of the science rather than where it is today
- Communicating internally and externally about innovation and vision
- Connecting with people across cultures and boundaries
- Promoting innovation that reflects patient and caregiver needs
This innovative spirit facilitates faster, more sensible, and sustainable changes to kidney disease care—so that all people, wherever they live in the world, will know that Fresenius Medical Care is present, listening, and responding with determination to help improve the lives of people living with kidney disease.
QUALITY ACROSS CONTINENTS
Prior to announcing the launch of the Global Medical Office, Fresenius Medical Care initiated a first-of-its-kind endeavor: the development and publication of the company's first global Clinical and Quality Agenda (CQA). The CQA outlines areas of medical and clinical focus across the company’s businesses around the world and is a key part of our efforts to enhance the quality and safety of patient care across the enterprise.
This complex, collaborative, evaluative process is the result of an annual planning and review process with our chief medical officers, Global Medical Office leaders, and clinical and medical teams around the world. The agenda looks broadly across the company to identify areas that need greater attention and to articulate opportunities for deeper collaborations and synergies on local, regional, and global levels by considering a full spectrum of themes and concepts (Figure 6).
FIGURE 6 | The CQA considers a full spectrum of themes, concepts, and areas of focus to improve and enhance global patient care quality
BUILD CORNERSTONES OF TRANSFORMATION: PURPOSEFUL, CONNECTED COMMUNICATION
As a global network of caregivers, creators, thought leaders, and innovators, Fresenius Medical Care seeks to build environments that are conducive to idea sharing, innovation, and progress. To unlock the global potential of shared purpose, we work with diverse communities to build robust pipelines of ideas and innovations.
With a view toward maximizing interconnected intelligence, Fresenius Medical Care considers the concept of "community" broadly, looking at communities through distinct lenses: knowledge communities, professional communities, and peer communities (Figure 7).
FIGURE 7 | Fresenius Medical Care nurtures communities both inside and outside the company as key sources of ideas and innovation
Knowledge communities are people and organizations with a common purpose who come together to share knowledge for the greater good. Whether a global data-sharing collaborative, a community-based research think tank, or a cross-industry initiative, the company and its thought leaders actively participate in collaborative endeavors that can make impacts on the science of kidney care as a whole.
There is great power in the ability to be understood by "someone like me." Peer communities enable individuals with like circumstances to share their experiences, find solutions for shared challenges, and look toward improving the future. Fresenius Medical Care actively participates in and nurtures peer communities, whether they are support groups of kidney disease patients and their caregivers, kidney care advocates, or patient education professionals.
Across the span of kidney disease care are remarkable individuals who make that care possible: nephrologists, nurses, dietitians, social workers, clinic managers, care coordinators, pharmacists, and others. A commitment to professional development of both our colleagues and their professions is a hallmark of the company's community focus and is one way we invest not just in our people but in the future of care itself (Figure 8).
FIGURE 8 | Value based care at work
The fast-growing global epidemic of chronic kidney disease demands immediate attention and a long-term strategy to cope with the implications of this worldwide challenge. I'm grateful to lead a group of people determined to harness the full potential of our interconnected intelligence to improve the lives of people with kidney disease by relieving their suffering and enabling them to lead productive and complete lives.
Fresenius Medical Care is transforming healthcare by addressing root causes of chronic kidney disease, slowing disease progression, enhancing global care quality, fostering idea sharing, and scaling innovations at both the local and global levels. By shifting from episodic, event-based, crisis-driven healthcare to continuous support models for patients across their life span journey of care, the company is changing the pattern of health delivery from reacting to health issues as they happen to predicting and intervening before a person is faced with a health crisis. This transformation will allow the global health system to recognize the importance of both medical and social support for patients living with a persistent illness, and to be a better partner to people around the world living with the challenges of chronic disease.
Meet Our Expert
FRANKLIN W. MADDUX, MD, FACP
Global Chief Medical Officer, Fresenius Medical Care
Franklin W. Maddux's distinguished career encompasses more than three decades of experience as physician, expert nephrologist, technology entrepreneur, and healthcare executive. He previously served as Executive Vice President and Chief Medical Officer for Fresenius Medical Care North America and joined Fresenius Medical Care in 2009 after the company acquired Health IT Services Group, a leading electronic health record (EHR) software company founded by Dr. Maddux. He developed one of the first laboratory electronic data interchange programs for the US dialysis industry and later created one of the first web-based EHR solutions, now marketed under Acumen Physician Solutions. A practicing nephrologist for nearly two decades, Dr. Maddux graduated with his baccalaureate in mathematics from Vanderbilt University and holds his MD from the School of Medicine at the University of North Carolina at Chapel Hill, where he holds a faculty appointment as clinical associate professor. His writings have appeared in leading medical journals, and his pioneering healthcare information technology innovations are part of the permanent collection of the National Museum of American History at the Smithsonian Institution.
- United States Renal Data System. 2018 annual data report. https://www.usrds.org/2018/view/Default.aspx; reference tables at https://www.usrds.org/reference.aspx.