During the German occupation of the Netherlands during World War II, biomedical engineer Willem Johan Kolff invented the hemodialysis machine and forever changed the way we treat kidney failure.
Kolff was able to pursue bold thinking that revolutionized his field in the midst of extraordinarily trying circumstances, and today, in the midst of the COVID-19 pandemic, we are again in need of revolution in kidney care during a trying time.
A year ago, the Department of Health and Human Services launched the Advancing Kidney Health Initiative, which laid out three bold goals: to increase adoption of at-home hemodialysis by 2025, to double the number of kidneys available for transplant by 2030 and to achieve a 25% reduction in the total number of patients progressing to kidney failure by 2030.
The timelines would have been ambitious in any circumstance, but since the announcement, the pandemic has plunged our lives, and our healthcare system, into an unprecedented challenge. Given this complication, major healthcare reforms, especially those for chronic, nonemergent conditions, could easily become delayed indefinitely.
But what the pandemic’s strain on our nation’s healthcare system has confirmed, however, is that we cannot shy away from bold action that is greatly needed.
COVID-19 has upended every aspect of our lives, kidney care included. After some of the first known cases of COVID-19 were seen in patients who had been receiving in-center dialysis, the entire kidney care industry launched a massive effort to limit contact and control infection in dialysis centers. Providers also greatly increased use of telehealth and virtual care to keep patients healthy and at home when possible—nonurgent telehealth visits increased as much as 4,000% during the initial phase of quarantine. Many experts expect increased use of telehealth will remain even after the pandemic. Despite the upheaval we’ve seen in healthcare in the last few months, the important reforms outlined in the Advancing American Kidney Health initiative have continued progressing.
We applaud the news that the voluntary payment models will move forward early next year. The only way to achieve bold goals is to align the financial incentives to support them. The voluntary models will do that by addressing advanced kidney disease in a way that reduces the amount of patients “crashing” into dialysis via the emergency room, and by encouraging more patients to adopt at-home dialysis.
The new model incentivizes reducing unplanned dialysis starts, increasing home-based dialysis, and prioritizing preventative care for patients with chronic kidney disease. This moves the focus from the current model of dialysis-based reimbursement and will lead to better outcomes for lower costs, delaying disease progression and shifting to more home-based dialysis.
Where more progress must be made is in reducing the overall number of people who reach kidney failure. Achieving this lofty goal will require two immediate actions.
First, our system of care must improve early identification of those who are at risk for kidney failure and act early to intervene and manage the progression.
To do this, we need forward-thinking care providers, but it does not end there. We need all the innovative minds and experts in their respective fields to work on this problem—clinicians who are on the front lines, researchers who are studying racial disparities in chronic disease identification and novel biomarkers of kidney dysfunction and faculty who are preparing the next generation of physicians.
Second, we know that kidney disease does not exist in a vacuum.
That’s why we need to move even further upstream than early detection and do more to prevent kidney disease before it occurs. Expanding access to nutrition support, medication adherence tools, and frequent preventive care can help, especially if we get these resources to communities that really need them. Black and Hispanic Americans are up to twice as likely to be managing chronic diseases, for example. Effectively addressing kidney disease, and a whole slate of other chronic conditions, requires addressing the systemic problems that lead to these conditions head-on.
If the last few months have taught us anything, it’s that we’re all in this together. We all have a role to play in tackling kidney disease.
The Advancing Kidney Health Initiative put us on the right path to achieve long-overdue changes to the status quo, and fortunately, we have not let the pandemic derail progress in kidney care. Our nation possesses some of the best minds and innovation in healthcare.
Now is the time to harness these capabilities to improve the quality of life of hundreds of thousands of Americans. If we don’t, we’ll be left waiting for change that may never come. And too many Americans can’t afford to wait.
Arvind Rajan is the CEO of Cricket Health.