Jeffrey Giullian knows how to get creative handling taxing circumstances.
As a nephrologist and longtime executive with DaVita Kidney Care, where some of his time had been spent serving on the emergency management team, Guillian was part of leading response plans to make sure thousands of patients in the path of natural disasters could still get care.
That included figuring out how a hospital in Beaumont, Texas—a city left without running water in the wake of Hurricane Harvey in August 2017—could still administer dialysis without water to its local patients. Giullian led the assembly of a large interdisciplinary team including nurses, local dialysis leaders, biomedical experts, the hospital’s acute dialysis medical director and colleagues from the dialysis machine manufacturer, NxStage, to come up with a low-water utilization dialysis workaround.
"I’ve always been in awe of the willingness from the nephrology community to come together and care for patients—even for patients that aren’t theirs," Giullian said. "It’s one of many things that fuel my passion for kidney health."
Earlier this year, Giullian took on the role of DaVita Kidney Care's chief medical officer and quickly found himself in the midst of a new challenge: making sure COVID-19 doesn't threaten some of the most at-risk kidney patients' health.
Last week, DaVita joined other U.S. dialysis providers in announcing a nationwide collaboration to fight the virus by working to keep patients out of the hospital in an effort to reduce the strain on the system while giving patients the care they need.
We caught up with Giullian earlier this year to talk about his new role in the increasingly prominent work of kidney care. But, as the world has changed greatly in the time since we first conducted this interview, we circled back around to learn about DaVita's response to COVID-19.
|More about Jeffrey Giullian|
Family: Married to Cindy (who is a nurse), daughter Julia is 12
Most important part of his morning routine: Early morning workout
A few words that describe his management style: Serving others, adding value
Advice he’d give his younger self: Join the military and serve your country
A book he recommends: "Crucial Conversations: Tools for Talking When Stakes Are High"
Biggest pet peeve: Pseudoscience and misrepresenting data
Favorite thing to do on his day off: Run, ski and spend time with loved ones
FierceHealthcare: What is your focus in this role?
Jeffrey Giullian: There was a time when DaVita truly was a dialysis company. That was our main focus. That’s what we did to help physicians and patients. And fortunately, my predecessor Allen Nissenson really set in motion a transition with senior leadership at that time to move from being just a dialysis company to being a kidney care company. That’s where I pick up.
My goals are for DaVita to, first and foremost, be a holistic kidney care company and, secondarily, to continue to innovate and develop strategic partnerships. We can not only decrease the progression of chronic kidney disease to dialysis but unfortunately, for those who ultimately need dialysis, give them many many more options for living a healthy and fulfilled life.
FH: What does that holistic kidney care look like?
JG: I think of care across the entire continuum. So early kidney disease, when patients don’t have any symptoms but when we have the greatest ability as healthcare providers to intervene, we educate to make a difference on comorbidities like diabetes and hypertension. For those patients who do have more advanced chronic kidney disease, starting to ensure that they get optimal treatment, again, so we’re slowing the decline of their decreasing kidney function but also managing all the other illnesses that come with that.
As patients develop more advanced kidney disease, they end up with bone issues, they can end up with anemia, they can end up with worsening cardiovascular health. The ability to intervene at that point, which we call upstream because it’s still before major negative manifestations, that’s the beginning of holistic kidney care. The entirety of holistic kidney care is taking care of the patient wherever they are on their journey.
FH: But while that kind of care sounds better, my understanding is the economics just haven't made sense in the past.
JG: The first thing I think of philosophically is when we provide good care to patients regardless, we will find a way because of that to be rewarded financially. That’s a little bit easier now than it would’ve been, say 10 years ago. Ten years ago, all of healthcare was in a fee-for-service world. In essence, as physicians, we were paid for taking care of illness, not paid so much for preventing illness. With the move from volume-based reimbursement to value-based reimbursement, there’s a greater ability for physicians and organizations to thrive both financially and otherwise in preventing illness and taking care of patients before they have the major sequelae of illness.
So for us very specifically, we’ve now taken care of 35,000 patients with chronic kidney disease in our integrated care systems, and we have really been using the past five, six, seven years to learn how to do that both from a patient care standpoint but also from a business standpoint.
FH: The Centers for Medicare & Medicaid Services seems to really be focused on changing reimbursement in kidney care, but then there are also challenges to reimbursement such as Prop 8 in California. Can you discuss some of the market forces at play?
JG: We’ve been fairly highly focused internally and somewhat externally over the past several years on three big issues: one is caring for patients with chronic kidney disease like I just mentioned, the second is increasing the number of patients that have the opportunity to dialyze at home. And getting involved with transplant centers and managing waitlists and getting more and more patients transplanted.
This has been our focus for several years, and it just so happens that is also what the government began to focus on, or at least began to advertise they were focused on, last year. When the executive order came out in July and the president announced that the focus was going to be slowing the rate of decline of chronic kidney disease or reducing the number of patients that go onto dialysis, increasing the number of transplants and increasing the use of home dialysis, we didn’t have to pivot. We didn’t have to make a change in how we sort of focus on things because that has been our focus for a while.
I’d say it has been nice for me as a physician and a former transplant nephrologist to really see the entire kidney community and to a broader extent the entire healthcare community talking about kidney disease in a way that I certainly didn’t experience five or 10 years ago. I think that is positive. There have been headwinds in terms of people trying to change the way we practice. I think that just goes along with being a major contributor to healthcare. We’re always going to face those headwinds, and I think that, in essence, some of them really make us stronger as a team because we think about ideas in a different way.
FH: How is COVID-19 changing how you do business?
JG: The COVID-19 crisis has resulted in some changes in our infection prevention protocols such as screening everyone who enters our centers and ensuring every patient and caregiver in our centers wears a surgical mask. And much has gone unchanged, because as a provider of life-sustaining dialysis treatments, we have always had the health and safety our patients and caregivers as a top priority.