The Provider’s Guide to Value-Based Kidney Care: A Physician-Approved Model for Improving Patient Care

Value-based care holds the potential to redefine how providers address the mounting challenges of managing chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Following the growth of value-based models in primary care,¹ nephrology stands out as an ideal specialty for value-based care to gain its next foothold.

Why nephrology? Nephrologists often serve as the quarterbacks of patient care, managing multiple, interconnected comorbidities associated with renal health. But providing this kind of holistic, patient-centered care is challenging in traditional healthcare delivery models, as it often requires additional resources and services that aren’t eligible for reimbursement under fee-for-service arrangements.

Fee-for-service models compensate providers for the quantity of services delivered, rather than the quality and outcomes of that care, effectively incentivizing a high volume of healthcare transactions. As an unintended consequence of this misguided incentive, patient experiences tend to become siloed and focused on addressing symptoms rather than preventing future issues.

In contrast, under value-based care models, providers are reimbursed based on their ability to demonstrate better outcomes at lower costs. This is particularly beneficial for nephrologists as it offers them greater autonomy to focus on delivering high-quality care and improving their patients’ overall health and quality of life.

Value-based kidney care empowers providers to focus on high-quality patient care

Value-based care reduces the clinical and emotional burden associated with advanced CKD and ESKD by focusing on empowering patient decision-making, protecting kidney health, and minimizing complications associated with kidney disease. The emphasis on care coordination also fosters collaboration among nephrologists, primary care physicians, and other specialists, enhancing the patient experience, elevating care planning, and closing care gaps. As a result, value-based models have been shown to improve patient outcomes by slowing progression of CKD, promoting home dialysis, and increasing transplant rates.

In addition to driving improved outcomes, value-based care can also help reduce clinicians’ administrative burden and prevent clinician burnout. This may sound counter-intuitive, as success in value-based care models does require upfront investment and culture change, including a sharpened focus on accurate and comprehensive clinical documentation. But value-based care can also grant providers access to tailored resources that are not available in fee-for-service models, such as:

• Specialized electronic health record (EHR) software with customized workflows to support evidence-based care and accurate clinical documentation
• Advanced risk stratification powered by machine learning and predictive analytics to identify high-risk patients and ensure timely, effective clinical interventions
• Wraparound care supported by an interdisciplinary care team to enhance patient engagement
• Administrative and clinical documentation support to create workflow efficiencies
• Customized reporting to drive continuous performance improvement
• Educational tools to empower patient decision-making

Value-based kidney care offers providers new revenue streams

Providers also have a financial incentive to participate in value-based care programs. By keeping patients well and out of the hospital, a value-based approach can improve patient outcomes and quality of life while also reducing the costs of managing CKD. When value-based care plans lead to cost savings, providers share in the financial benefits and may also have access to performance bonus payments, such as those available through the government’s value-based kidney care model.² This direct alignment between financial rewards and improved clinical outcomes supports the type of personalized, patient-oriented care clinicians want to provide.

While most kidney patients are still in fee-for-service models, as healthcare utilization rates continue to rise the government and commercial payers are moving more patients to value-based care arrangements to help manage costs. In 2024, nephrologist Dr. Carl Fisher estimated five to ten percent of the total patient population at Metrolina Nephrology Associates, where he serves as president, was in value-based care models. In the future, he expects almost all patients to be covered in value-based care contracts and that provider optimism in value-based care will grow as opportunities for shared savings increase.

Related reading: How One Nephrology Practice Earned a Perfect Total Quality Score in the Government Value-Based Kidney Care Choices Model

Best practices for navigating the transition to value-based kidney care

Providers can ease the transition to value-based kidney care by adopting evidence-based care pathways and advanced technology for the early detection and management of kidney disease, focusing on patient and provider education, and promoting interdisciplinary collaboration among healthcare teams. Here are a few essential steps to implement these strategies.

• Prioritize prevention: Value-based care in nephrology encourages proactive disease management through early identification and intervention to slow disease progression. Prioritizing prevention and wellness helps people manage their kidney disease as well as comorbidities such as high blood pressure, diabetes, and other conditions that contribute to CKD progression.
• Develop and train interdisciplinary care teams: Care coordination among nephrologists, primary care physicians, social workers, behavioral health practitioners, and other health specialists is fundamental to the success of value-based care in nephrology. In effective value-based kidney care programs, nephrologists often collaborate with renal care coordinators (RCCs), specialized nurse practitioners, advanced practice providers (APPs), nurse care managers, social workers, renal dietitians, and kidney care advocates (KCAs) to ensure patients receive seamless, efficient care.
• Enhance risk stratification with purpose-built technologies and artificial intelligence (AI): Specialized EHRs and AI-driven predictive analytics can be used to identify patients in value-based models, determine their level of risk for CKD, and develop appropriate care plans—enhancing payer-provider collaboration and improving clinical outcomes. Advances in other technologies, such as telemedicine and remote patient monitoring, also help enable effective care delivery and outcome tracking.
• Focus on patient education: CKD patients benefit from personalized patient education and resources that can help them make informed decisions about their health, their plan of care, and their treatment options. For example, tools such as bilingual videos, take-home print materials, and one-on-one sessions with clinical educators can contribute to fewer patient no-shows, improved patient satisfaction, and better outcomes. CKD health education is provided by nephrologists and other members of the care team through patient visits, online resources, support groups, and community programs.
• Find the right partner to help ease the transition: Value-based care companies offer resources such as administrative support and purpose-built technologies to enhance the scalability of value-based models, enabling better care delivery and resource management. As the leading provider of value-based kidney care with the largest nephrologist network and the most broadly adopted nephrology specific EHR, Interwell Health invests in innovation and resources to tailor solutions that address each provider’s unique needs—from improving patient care to growing a successful practice.

Dr. William McElhaugh, a nephrologist with the Kidney Care Specialists (KCS) group in Philadelphia, partners with Interwell to enable the success of his practice’s value-based care program. He says working with an embedded RCC has helped improve compliance, optimal starts, and patient outcomes, and that using the Acumen Epic Connect EHR gives his care team time back to focus on patients. “It would be difficult to do a value-based care program without a partner like Interwell to determine and then take on some of the risk,” he said. “I don't know how even a large practice would be able to manage that themselves."

Value-based models are key to kidney care transformation

Value-based kidney care offers transformative benefits for patients and providers. Patients experience improved outcomes and quality of life, thanks to proactive, preventive care, holistic kidney health management, and personalized CKD education. Providers gain access to tools and resources that enhance care quality and efficiency, resulting in elevated care planning, reduced administrative burden, and better patient-reported and clinical outcomes.

When early interventions and better kidney care coordination lead to improved population health management and fewer hospitalizations, payers also benefit in the form of improved member outcomes, higher quality ratings, and cost savings. By aligning incentives and focusing on outcomes, value-based care in nephrology is a win-win-win opportunity.

For more about how value-based kidney care can benefit your practice, visit our physicians page.

 

Resources

1. McKinsey: Investing in the new era of value-based care. https://www.mckinsey.com/industries/healthcare/our-insights/investing-in-the-new-era-of-value-based-care
2. CMS: Kidney Care Choices (KCC) Model. https://www.cms.gov/priorities/innovation/innovation-models/kidney-care-choices-kcc-model