An Executive Order was signed last week in order to launch "Advancing American Kidney Health," an initiative enacted to improve the quality of life for patients living the United States with kidney disease, expand treatment options, and reduce health care costs. The 3 goals of the initiative are: fewer patients receiving developing kidney failure, fewer patients in the United States receiving dialysis in dialysis centers, and more kidneys available for transplant.

In following with the Executive Order, the US Department of Health and Human Services (HHS) also announced that the Centers for Medicare & Medicaid Services (CMS), through its Center for Medicare and Medicaid Innovation (CMMI), has released a proposed required payment model and 4 optional payment models to adjust payment incentives to encourage preventative kidney care, home dialysis, and kidney transplants.

“Decades of paying for sickness and procedures in kidney care, rather than paying for health and outcomes, has produced less-than-satisfactory outcomes at tremendous cost,” said Alex Azar, HHS Secretary. “Through new payment models and many other actions under this initiative, the Trump Administration will transform this situation and deliver Americans better kidney health, more kidney treatment options, and more transplants.”

According to the National Institute of Diabetes and Digestive and Kidney Diseases, more than 661,000 Americans have kidney failure. Of these, 468,000 individuals are on dialysis, nearly 100,000 Americans are waiting on the list to receive a kidney transplant. Kidney disease ranks as the 9th leading cause of death in the United States.

Approximately 20% of dollars spent in traditional Medicare, or approximately $114 billion a year, are used on Americans with kidney disease. Yet of the more than 100,000 Americans who begin dialysis to treat end-stage renal disease annually, 1 in 5 will die within a year. Therefore, the HHS has laid out 3 goals for improving kidney health:
  • Reduce the number of Americans developing end-stage renal disease by 25% by 2030
  • Have 80% of new ESRD patients in 2025 either receiving dialysis at home or receiving a transplant
  • Double the number of kidneys available for transplant by 2030
To reduce the development of end-stage renal disease, the CMMI also released a set of 4 optional payment models. These models are expected to enroll more than 200,000 Medicare patients in arrangements that give providers new incentives for preventing kidney disease and managing kidney patients’ health in a more comprehensive and person-centered way.

One such payment model, known as ESRD Treatment Choices, will enroll all dialysis providers in approximately half of the country and provide new incentives to encourage dialysis in the home. To enhance patient access to transplantable organs, all 5 new payment models will give providers new incentives to help eligible patients receive transplants.

The executive order calls on HHS to launch a public awareness campaign on CKD, reform the organ procurement and management system in the United States, expand support for living donors through compensation for costs, such as lost wages and child care expenses; and encourage the development of wearable or implantable artificial kidneys.

During the American Diabetes Association Annual Meeting in San Francisco from June 7-11, 2019, Jay Elliot, the senior scientist at Bayer Pharmaceuticals, sits down with Pharmacy Times to discuss the correlation between kidney disease, diabetes, and cardiovascular disease.




References
  1. HHS Launches President Trump’s ‘Advancing American Kidney Health’ Initiative [press release]. HHS website. Published July 10, 2019. https://www.hhs.gov/about/news/2019/07/10/hhs-launches-president-trump-advancing-american-kidney-health-initiative.html. Accessed July 17, 2019.
  2. Kidney Disease Statistics for the United States. NIH website. https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease. Accessed July 17, 2019.