I spent this rainy morning shadowing a pediatric nephrologist, the specialists for kidney function in kids. The number of conditions they see is vast, but each has a unique course and some can progress to renal failure, even with medical intervention.
Chronic renal failure is the result of slowly progressive kidney diseases (and it not often reversible). 1 in 3 American adults is at risk for kidney disease — the two main causes of CKD in the adult population are diabetes and high blood pressure. In kids, CKD is often associated with inherited disorders, malformations present at birth, and autoimmune diseases, to name just a few.
Eventually, CKD can progress to end stage renal disease (ESRD) and patients will be started on dialysis and/or placed on the kidney transplant list. Just under 15% (30 million individuals) of U.S. adults have CKD. Nearly 6,000 children (<18 years old) and 750,000 adults in the U.S. are affected by ESRD.
ESRD is a special category of Medicare eligibility. It provides health insurance for people of any age with ESRD. Those with ESRD are 1% of the Medicare population but account for 7% of the Medicare budget. Medicare spending for ESRD patients was $35 billion in 2016. Combined with Medicare spending for CKD, expenditures top $114 billion – this amount grows annually, partially due to more individuals developing CKD and ESRD.
The Comprehensive ESRD Care Model was designed by CMS to identify, test, and evaluate new ways to improve care for Medicare ESRD beneficiaries. In this model, dialysis clinics, nephrologists and other providers create an network to coordinate care. It builds on the experience of Accountable Care Organizations, which aim to reduce health care costs by encouraging doctors, hospitals, and other providers to form networks that coordinate care, reduce unnecessary costs, and earn bonuses when care is delivered more efficiently. 👏🏼 for value-based care!