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What Is the Value Based Kidney Care Model?
Fresenius Medical Care is dedicated to improving the lives of people with chronic kidney disease (CKD) and end stage renal disease (ESRD). We’ve asked ourselves, how can healthcare organizations improve patient outcomes and reduce costly hospitalizations?
Value based care payment models provide financial incentive for physicians and care providers as well as drive improved patient outcomes while reducing total cost of care.
Fee for Service vs. Value Based Care
Fee-for-service (FFS) models have been the standard in healthcare organizations for years and are still the primary reimbursement method. Under these models, physicians are paid based on the services they deliver to a patient whereas with a value based care model, physicians’ and care providers’ payments are based on outcomes. In other words, FFS rewards the amount of care provided while in value based care it is the quality of the care that is rewarded.
Value based care models shift the focus away from a single treatment or service and take a more holistic approach to caring for the patient. FFS models reward quantity over quality. It’s not to say that physicians and care teams aren’t providing great care under these models, but they aren’t financially incentivized to provide care coordination to the extent that they are with value based care programs.
The COVID-19 pandemic highlighted the susceptibility of FFS models. As voluntary patient visits to clinics and hospitals decreased, it had a direct impact on physician and hospital revenue. A survey by the American Medical Association1 reported that medical revenues dropped by 32 percent on average during the pandemic. However, the pandemic had less of an impact on value based care systems, which focused on patient outcomes rather than the number of visits.
Reducing Total Cost of Care
Value based care creates a funding mechanism to invest in care coordination strategies — or technologies — that improve patient outcomes and ultimately reduce total cost of care.
Providers in value based care programs are responsible for the patient’s overall care. Since their knowledge may be limited to their specialty, they often bring in partners to help care for other aspects of the patient’s health. By leveraging these partnerships and caring for the patient’s overall health, it often eliminates avoidable trips to the emergency room or hospital. The cost savings from reduced hospitalizations is shared by the providers in the value based care model and can be reinvested into care coordination solutions.
There are several factors that impact a CKD patient’s health outside of the visit with the provider, such as scheduling appointments, finding transportation, medication adherence, and nutrition. The cost savings from improving patient outcomes and reducing hospitalizations can be used to help provide personalized, reliable, and high-quality coordinated care to patients.
Driving Innovation and Improved Patient Outcomes
Providing care coordination services and support to patients can help drive improved patient outcomes by caring for the patient beyond the visit. Under value based kidney care models, physicians are incentivized to treat the patient holistically, rather than solely for the symptom that brought them in. For example, providing patients with the following can help them better manage their overall kidney health:
- Best-in-class education focused on managing kidney disease and related comorbid conditions, eating well, and managing medications
- Increased access to a nephrologist
- Support programs with access to kidney experts like renal dietitians, social workers, and nurses
- Timely interventions identified through predictive models
- Coordinated care services
Educating patients about managing their comorbidities can also help drive improved patient outcomes. Given that diabetes and high blood pressure are the leading causes of kidney failure, educating patients with chronic kidney disease about managing these comorbidities can help them feel their best and slow the progression of kidney disease.
Our value based care business, Fresenius Health Partners, leverages real-time clinical data to anticipate problems before they arise and take action to help patients and their care teams address the situation before an avoidable hospitalization occurs — whether a patient requires assistance during a natural disaster, medication support, nutritional guidance, transportation, or scheduling doctors’ appointments. Through their collaboration with Fresenius Kidney Care, Fresenius Health Partners has reduced hospitalizations by more than 34 percent for patients with ESRD in our value based care programs over a five-year period.
The KidneyCare:365 Health Programs are a key part of our value based care offerings, focused on supporting people living with CKD and ESRD through increased access to nephrologists, personalized education, hands-on support from a team of kidney experts, timely interventions, and expanded care coordination services to help better manage their chronic condition.
Through these programs, we work directly with InterWell Health, the country’s largest network of independent high-performing nephrologists. These physician-led partnerships help to identify best practices for driving better patient outcomes and reducing overall cost of care. As part of this cooperation, the InterWell Health nephrologists review and evaluate educational resources to identify the best resources for patients across the continuum of care. They’ve also developed clinical practice guidelines, setting the clinical standards for the network, as well as care coordination strategies to drive optimal care.
By combining the skills of a diverse group of nephrologists, along with Fresenius Medical Care North America’s extensive renal expertise, and proven predictive modeling, we are optimizing the quality and efficiency of delivering value based care. Through the KidneyCare:365 Health Programs, we’re able to leverage our expertise and partnerships to support the unique needs of people with CKD and ESRD.
Shaping the Future of Nephrology
Although FFS has been the standard in this country, the unintentional consequence has been a push to value the quantity over the quality of care. In the current environment of rising healthcare costs, more and more payor organizations are turning to value based care solutions, particularly in nephrology and treating CKD patients.
Based on the trends, it appears value based kidney care is here to stay and will continue to impact the future of healthcare, encouraging care teams to implement innovative solutions to deliver superior care that improves patient outcomes and reduces the overall cost of care.
For more information about the ideas shaping the future of global healthcare, read our 2021 Global Annual Medical Report.
- “COVID-19 Physician Practice Financial Impact Survey Results,” American Medical Association, accessed December 3, 2021, https://www.ama-assn.org/system/files/2020-10/covid-19-physician-practice-financial-impact-survey-results.pdf.