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Note: Current through June 30, 2019; Data: United Network for Organ Sharing; Chart: Chris Canipe/Axios

President Trump signed an executive order yesterday modernizing kidney disease care for the first time in decades, a move that could reduce spending and improve treatment for one of the country's most pervasive illnesses.

Why it matters: This could be a big deal for the 37 million Americans suffering from chronic kidney disease, including 726,000 with kidney failure.

The big picture: The executive order requires Medicare to test different payment models encouraging preventive kidney care, home dialysis (versus facility-based dialysis) and kidney transplants.

  • The administration will also push for the development of artificial kidneys and speed up the kidney matching process so that more people can get transplants.
  • Almost 100,000 Americans are waiting for a kidney transplant, by far the most common organ transplant, and more than 100,000 begin dialysis each year.

The administration's goals are ambitious: It wants to reduce the number of patients with kidney failure by 25% by 2030, have 80% of patients who do develop it in 2025 either receive home dialysis or a kidney transplant, and double the number of kidneys available for transplant by 2030.

What they're saying: Encouraging home dialysis would obviously shake up the business models of dialysis clinic operators, namely the duopoly of DaVita and Fresenius. But they've already been moving in this direction, said Dan Mendelson, founder of Avalere Health.

  • "Home dialysis isn’t a full replacement for traditional dialysis, and the large chains have been preparing for this evolution for years," he said.

The bottom line: The focus on home dialysis and prevention are good for patients, and the executive order "could also reduce federal cost somewhat if implemented properly – but we need more detail to really assess that," Mendelson said.

Go deeper: The growing toll of kidney disease

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