I lost my father almost three years ago to kidney failure.
He had experienced the full journey of challenges, from an auto-immune disorder that rapidly destroyed his kidney function, to outpatient dialysis treatment three times a week, then a transition to home dialysis, and finally to receiving a donor kidney, which gave him a high quality of life for another five years.
Our experience together helped define what I realized to be an incredible need—and incredible opportunity—to bring more value-based care options to patients.
We are entering a period of rapid innovation in kidney care that is transforming the model for how we support patients earlier and drive change. These new models incentivize earlier education, mental health support, care coordination and offer tools to intervene and slow the progression of disease that are unavailable in a fee-for-service model. And the early results of some of these models are incredibly exciting.
The status quo in kidney care has been failing everyone for too long, with a lack of focus on prevention amid soaring costs. In my time as the Department of Health and Human Services Secretary, I was determined to change this and announced the Advancing American Kidney Health Initiative in 2018.
This shifted more attention and resources toward managing chronic kidney disease (CKD) before kidney failure, better educating patients on treatment options, increasing transplants, and driving more dialysis care to the home, where people prefer to receive treatment.
We also helped create an environment where value-based care providers could succeed and flourish. This wave of innovation includes new tools to identify kidney disease earlier, predictive analytics to determine those most at risk of complications, new technologies to increase the adoption of home dialysis, and next-generation solutions like xenotransplantation. The private sector is offering a wide variety of solutions to meet this challenge.
Solving this challenge is an urgent matter. Not only is kidney disease a chronic condition with extreme impacts on patient health and quality of life, but it’s also a significant cost burden. In 2019, 15% of Medicare beneficiaries with CKD and kidney failure cost Medicare $124.5 billion—that’s $1 out of every $5 spent in Medicare—and tens of billions of these costs could be prevented with better care management and early identification.
More than 37 million Americans live with CKD and 90% don’t even know they have it. Far too many eventually crash into the emergency room needing urgent dialysis having never received the early education and support they needed.
The challenging road experienced by my dad—and so many others—would be better with more tools and support for managing this complex disease. That’s why large health plans from Humana to Cigna, are seeking out new innovative value-based partners that are guaranteeing they can improve patient outcomes while lowering costs. The result is innovation, new models of care, earlier interventions, improved health equity, more holistic patient-centered care, and big changes finally coming to kidney care.
To push this new standard of kidney care forward, I have joined the board of directors at Interwell Health, a new kidney care management company that partners with a network of 1,600 nephrologists across the country on a mission to reimagine kidney care. Using a model of innovative technology, high-touch personal coaching and physician collaboration, they have significantly lowered hospitalizations and increased planned starts to dialysis, avoiding the need for emergency treatment. I'm optimistic that with this work and the work of many other innovators, in 10 years, a kidney disease diagnosis will look nothing like it does today.
What that will take, however, is the ongoing alignment across policy leaders, healthcare professionals and the private sector to make this a priority.
My dad was lucky: he got the care and support that he needed to manage his condition and get a transplant. These resources can and should be available to everyone—and innovative, value-based care companies in the private sector are on the road to ensure they are.
It’s on all of us: doctors and hospitals, payers and patients, the public and private sector, to get this right and dramatically improve kidney disease outcomes.
Alex Azar served as the 24th Secretary of the U.S. Department of Health and Human Services from 2018 to 2021. He is currently a member of the board of directors at Interwell Health.