How the Quintuple Aim Healthcare Framework Can Improve Kidney Care

What is the Quintuple Aim in healthcare?

The Quintuple Aim is a healthcare framework intended to guide improvements in the quality of healthcare. It encourages a holistic and personalized approach to care while addressing broader systemic challenges. The five pillars of the Quintuple Aim are:

• Enhancing patient experience
• Improving population health
• Reducing costs
• Improving provider work-life balance and well-being
• Advancing health equity

The concept of the Quintuple Aim originated in 2007. Back then, it was called the Triple Aim and included only three elements: improving patient experience, better outcomes, and lowering costs. Then, in 2014, the Triple Aim was expanded to the Quadruple Aim with the addition of a fourth component: clinician well-being. In 2021, the Quadruple Aim evolved into the Quintuple Aim with the addition of the fifth element: advancing health equity.

How the Quintuple Aim applies to kidney care

In kidney care, we often talk about the goals of the Quintuple Aim in the context of new value-based care models, which the government and private payers are increasingly driving toward. According to the Centers for Medicare & Medicaid Services (CMS), value-based care is “designed to focus on quality of care, provider performance, and the patient experience.” CMS also states that value-based care advances health equity by focusing on outcomes across populations and screening for social needs to personalize care.¹ Sound familiar?

Based on CMS’s definition of value-based care, there are indeed obvious overlaps with the Quintuple Aim. When you look more closely, you will see that value-based care aligns closely with the Quintuple Aim and distinctly supports all five goals of the healthcare framework.

1. Quintuple Aim Goal #1: Improving patient experience

How a person experiences the healthcare system can hugely influence how engaged they are in managing their own health. Take, for instance, a person who was recently diagnosed with chronic kidney disease (CKD) and told by their provider that the reason they are sick is because they neglected to manage their diabetes and hypertension. The provider sends this person home with a warning that failing to manage their compounding chronic illnesses will result in additional kidney damage and eventually they will need to start dialysis.

Now, imagine that same person walks away from their initial diagnosis feeling educated and supported, rather than shamed and scolded. They might still feel overwhelmed and scared, but they know they have a care team that will walk them through how to manage their disease and what treatment options are available. That person is now much more likely to be engaged, make follow-up appointments, follow their care team’s guidance on any lifestyle changes, and have a better outcome.

Value-based kidney care focuses on improving patients’ overall physical and mental wellness by providing support, coordinated care services, and customized resources to help patients live their best and healthiest lives. When people living with kidney disease have access to the care, patient resources, and support they need, they can spend less time worrying about their health and more time focusing on what brings them joy. As a value-based kidney care provider, Interwell Health helps improve patient quality of life with:

- Personalized care plans and customized resources to help with prescription management, eating well, and more

- Access to the largest, most trusted network of nephrologists in the nation

- Support from a dedicated, interdisciplinary care team, including nurses, dietitians, and social workers

- Coordinated care services, including appointment scheduling for doctor or specialist visits

2. Quintuple Aim Goal #2: Advancing population health

The term “population health” as it’s used today originated in the 1990s when clinical researchers proposed a new field of healthcare that focused on linking health outcomes with patterns of health determinants.² As one of the most common chronic diseases in the U.S., CKD has significant impacts on population health. More than one in seven U.S. adults — about 35.3 million people — has some stage of kidney disease, although many do not know they have it until the disease has progressed to an advanced stage.³

Value-based kidney care is centered around prevention, whole-patient health, and managing comorbidities. It focuses on earlier identification and helping patients take advantage of all the resources, support, and medication available to better manage and slow kidney disease progression. This, in turn, improves population health.

Interwell works closely with payers and nephrology practices to identify high risk patients using machine learning, allocate resources efficiently, and recommend proactive care to improve population health. In addition, Interwell partners with primary care providers (PCPs) to increase PCP education, referral recommendations, kidney-specific patient support, coordination with nephrologists, and incentives focused on providing high-quality patient care. PCPs are key to improving population health through screening to increase early detection of kidney disease.




3. Quintuple Aim Goal #3: Reducing costs

Hospitalizations and readmissions are among the biggest cost drivers for the care and management of CKD. In fact, CKD is among the top five principal diagnoses with the highest rate of 30-day all-cause adult readmissions, with more than one in five adult hospitalizations for CKD resulting in subsequent readmissions within 30 days of discharge.⁴

As Interwell CEO Bobby Sepucha has shared, driving sustainable change to create a better future for people living with kidney disease is only possible if we can measurably drive down the cost of care for managing CKD. Value-based kidney care can help decrease the costs of care by focusing on early detection, improved access, patient education, comorbidity and medication management, and addressing social determinants of health (SDoH) to reduce hospitalization and readmission rates. This approach is saving the healthcare system money; for instance, Interwell helped one health plan save $3.6 million by reducing member hospitalizations more than 30 percent.




4. Quintuple Aim Goal #4: Improving provider work-life balance

In the 2014 Frontiers of Medicine article “The Grand Challenge of Nephrology,” the authors suggest negative perceptions about long hours, a focus on a chronically ill and complicated population of patients, and uncertainty about the future of the discipline were causing the subspecialty to go out of favor. ⁵ Since then, caring for patients with CKD has only grown more challenging, with many nephrologists serving essentially as the primary physicians for patients with multiple, complex comorbidities.

Today, an increasing number of nephrologists are embracing value-based models that address these challenges and provide the support they need, including technology, tools, clinical documentation resources, and collaboration with an interdisciplinary care team. As a physician-led value-based kidney care provider, Interwell offers provider enablement services — including administrative tools, customized reporting, patient education, and care coordination — that are purpose-built to reduce providers’ administrative burden, save them time, and empower them to focus on their patients.

5. Quintuple Aim Goal #5: Addressing health equity

Communities of color are disproportionately impacted by many chronic diseases, including CKD. CKD prevalence is higher among Black adults than in any other group, while the prevalence of end-stage kidney disease (ESKD) is nearly four times higher among Black adults compared to white adults.⁶ To begin to address health disparities, the kidney care community must look at social and environmental factors such as food insecurity, housing instability, and lack of transportation that can increase the risk of developing kidney disease and create barriers to care and treatment for patients with CKD.

A value-based kidney care model helps ensure patients receive comprehensive care, which means the right support at the right time to advance health equity strategies and improve outcomes. It can be especially challenging to manage an illness if you are struggling to meet your basic needs, and Interwell is committed to helping address healthcare disparities so more people with kidney disease can get the care and support they need. Interwell uses SDoH data from provider and payer partners and advanced machine learning to identify vulnerable individuals and target interventions where they're most needed. Interwell also connects patients with resources to help them access nutritious food, support in the home, and transportation to clinical appointments.

Why is a patient-centered approach important in kidney care?

A patient who is engaged, educated, and empowered can actively take steps to slow the progression of CKD, lower their risk of complications, and improve their general health and quality of life. Conversely, without patient education and activation, too many patients “crash” into dialysis, meaning their untreated kidney disease progresses to a point where they need urgent care before they’ve spoken with kidney specialists and developed a treatment plan.

Ultimately, the goal of value-based kidney care is to keep kidneys healthy, slow disease progression, and delay kidney failure for as long as possible. One of the best ways to do that is to adopt a patient-centered approach that is focused on improving patient experience and outcomes while lowering the total cost of kidney care — all in alignment with the Quintuple Aim.

The benefits of the Quintuple Aim in managing kidney health

The Quintuple Aim offers a useful framework to guide improvements in managing kidney health. In alignment with the Quintuple Aim, value-based kidney care takes into account not only what’s best for patients, providers, and payers, but what is best for the healthcare system and our communities at large.

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¹ CMS: Value-Based Care. https://www.cms.gov/priorities/innovation/key-concepts/value-based-care  

² American Journal of Public Health: What is Population Health? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447747/ 

³ Agency for Healthcare Research and Quality: Clinical Conditions With Frequent, Costly Hospital Readmissions by Payer, 2020. https://hcup-us.ahrq.gov/reports/statbriefs/sb307-readmissions-2020.jsp

⁴ Agency for Healthcare Research and Quality: Clinical Conditions With Frequent, Costly Hospital Readmissions by Payer, 2020. https://hcup-us.ahrq.gov/reports/statbriefs/sb307-readmissions-2020.jsp

⁵ Frontiers of Medicine: The Grand Challenge of Nephrology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291843/ 

⁶CDC: Chronic Kidney Disease in the United States, 2023. https://www.cdc.gov/kidney-disease/media/pdfs/CKD-Factsheet-H.pdf