Jul 11, 2019

Trump wants to stem the tide of kidney disease

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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

Go deeper

Whistleblower alleges DaVita, Fresenius paid kickbacks

Fresenius is one of the largest U.S. dialysis providers. Photo: Arne Dedert/picture alliance via Getty Images

A whistleblower lawsuit alleges dialysis giants DaVita and Fresenius padded their profits by donating money to the American Kidney Fund charity, which in turn subsidized patients' premiums as a way to steer them toward insurance plans that pay the dialysis firms particularly well, Bloomberg reports.

The big picture: The Department of Justice did not intervene in the lawsuit, and the companies did not immediately respond for comment. But the lawsuit reignites the debate of whether this technically legal practice is a violation of anti-kickback law, and when the federal government will propose another rule to clear the air.

Health Care Vitals: Chicago

Kai Tao, Founder of Juno4Me, discusses the importance of preventative care at the Axios roundtable. Photo: Chris Dilts for Axios

This Wednesday, Axios' Sam Baker hosted an Expert Voices Live discussion in Chicago, digging into the state of health care access and affordability in Illinois.

Local leaders, health tech innovators, and advocates discussed solutions to challenges in health care policy and providing equitable, high-quality care.

Creating inclusive and comprehensive health care

How to measure the impact of effective care was a significant topic of conversation, as well as the fundamentally integrated nature of health across dental care, reproductive care, mental health services, and more.

  • Clark Stanford, Dean of the College of Dentistry at the University of Illinois at Chicago, discussed how dental health acts as a useful indicator for a person's overall health: "Health disparities are revealed in dental care — dental care reflects a patient's larger quality of life."
  • Felicia Davis, President and CEO of the Chicago Foundation for Women, unpacked the importance of measuring health outcomes versus outputs: "For example, if we give a girl a backpack, does her attendance improve? While saying we donated one thousand backpacks is measuring the output, we want to be measuring outcomes."
  • Paula Thornton Greear, Vice President of External Affairs for Planned Parenthood of Illinois, expressed support for measuring outcomes over outputs, and approaching the concept of health as not subdivided into different fields: "In reproductive health...we need to work with our partners in the mental health space. We need to put our best foot forward, but we can’t do it in a silo."
How to use data in providing better care

As health providers become increasingly dependent on data, the importance of accurate and accessible information is paramount in providing effective care.

  • Bonnie Lai, Head of Technology at Lumere, advocated for a more integrated approach to health data: "We need data to understand the needs of patients, but the data is siloed and it’s hard to break out of that."
  • Jason Montrie, President of Pareto Intelligence, stressed the need to make data more accessible to patients: "How do we democratize this data? That structure needs to be furthered. Patients should be able to change [their information] so it's always updated and accurate. [And then] how do we take the whole picture of someone, and give that to [a health care provider] who can act on that information?
Health insurance and challenges of access to care

Challenges presented by the complexities of the current systems and addressing the needs of all patients featured prominently in the conversation.

  • Laura Starr, Director of Development and Communications at CommunityHealth, focused on the importance of preventative and integrated care: "We need to do what’s most cost effective and that’s prevention...and integration makes everything more effective."
  • Kai Tao, Founder of Juno4Me discussed the challenges of the current health care systems and addressing the needs of different populations: "There are really three different health systems: Medicaid, employer-based, and Medicare. How can we lift everyone up? Especially when there are different levers, different populations to serve. What this goes back to is to start people young and focusing on preventative care."
    • Regarding the cherry-picking of patients with different types of coverage: "The reality is that dentists don’t want to see Medicare patients."

Thank you Delta Dental for sponsoring this event.

Keep ReadingArrowJul 25, 2019

A small group of patients account for a whole lot of spending

Illustration: Rebecca Zisser/Axios

A very small group of patients with major illnesses is responsible for an outsized share of health care spending, and new data show that prescription drugs are a big part of the reason their bills are so high.

The big picture: Among people who get their coverage from a large employer, just 1.3% of employees were responsible for almost 20% of overall health spending, averaging a whopping $88,000 per year.

Go deeperArrowJul 29, 2019