Availability of Kidney Care at Home Moving the Needle on Disease Outcomes, Experts Say

McKnight’s Home Care | By Adam Healy
 
Alternative payment models, technological innovation and a shifting focus to the home are advancing health outcomes and equity for Americans with kidney disease, according to experts.
 
The Centers for Medicare & Medicaid Services (CMS) this month released its first annual evaluation of the End-Stage Renal Disease (ESRD) Treatment Choices Model (ETC), and the initial results are positive. The report found “modest early gains” in home dialysis training and transplant rates, laying a strong foundation for the future of in-home renal care.
 
The model, which was introduced Jan. 1, 2021, was designed to push for greater utilization of in-home renal care services.
 
“The ETC Model establishes incentives to encourage greater use of home dialysis and kidney transplantation, while reducing Medicare expenditures and preserving or enhancing quality of care provided to beneficiaries with ESRD,” CMS said. “By supporting patient selection of home dialysis and transplant through enhanced patient education, and other strategies, the model is intended to result in lower Medicare payments while preserving or enhancing quality of care for beneficiaries.”
 
Alternative payment model driving change
 
In an interview with McKnight’s Home Care Daily Pulse, Nathan Goldstein, CEO of community-based renal care provider Duo Health, explained that alternative payment models like ETC have steadily moved kidney care to the home. Following this trend, Duo Health recently partnered with National Kidney Partners to deploy a value-based care model in Florida. The model aims to lift barriers to care access and provide holistic support for kidney disease patients, according to a release.
 
Also recently, Strive Health partnered with Prominence Health Plan to provide value-based renal care in Nevada through services like telehealth and enhanced care coordination.
 
In 2016, rates of home dialysis hovered around 12%, said Goldstein. Since then, payment models such as ETC and technology have helped to increase utilization. Services such as blood pressure monitoring, glucose management and kidney tests are becoming more convenient and less expensive, allowing people to integrate them into their daily lives at home, said Joseph Vassalotti, MD, chief medical officer at the National Kidney Foundation, speaking with McKnight’s Home Care Daily Pulse. As an added bonus, these advancements can increase patient education as people learn more about their health “goalposts” and how to reach them. 
 
“Home dialysis, particularly, is a welcome advance. I think many of the alternative payment models speak to that, and ETC is one of them,” Vassalotti said.
 
Many patients prefer in-home dialysis, he said, and it incurs a lower cost to taxpayers than clinical care. There are other benefits to kidney care at home beyond costs. Moving services to the home can improve patient’s comfort, convenience and access to care, he said. 
 
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