Ep 168 – Crossing the Chasm in Kidney Care: The Value Bridge between Clinical Nephrology, Technology, and Policy, with Dr. Adam Weinstein

What this episode covers

In the universe of value-based care transformation, there has been one disease that represents a metaphorical black hole, where the gravitational pull of fee-for-service is so strong that nothing can escape. These patients experience the fullest depths of pain and despair, and this chasm is so deep and wide that there is only darkness. You may have guessed it, but we are talking about chronic kidney disease, a condition that impacts 37 million people in the U.S. The suffering of those inflicted with CKD is so immense, yet the Medicare reimbursement system is designed to fail this patient population. In fee-for-service medicine, we wait until patients succumb to end-stage kidney disease, where they crash and burn and need costly dialysis to stay alive for a little while longer. Because of this flawed reimbursement model, Medicare pays over $125 billion for people with all stages of renal disease, which is around 20% of all Medicare spending!  Unless we go upstream and start engaging patients prior to kidney failure, success in value-based kidney care will be limited.  We must “give life” to this patient population in the Race to Value! The giving of life and that is what DaVita Kidney Care is doing.  In fact, the name DaVita is an adaptation of the Italian phrase for giving life. In value-based care, DaVita works with healthcare payers and providers to develop and implement care delivery models that focus on improving outcomes and reducing costs for CKD patients. And I am excited to share with our listeners, that our guest this week is Dr. Adam Weinstein, the Chief Medical Information Officer for DaVita. Dr. Weinstein works across numerous lanes helping bridge the intersection of IT, clinical nephrology, and healthcare policy. He is focused on delivering IT tools that take advantage of DaVita’s clinical data and help nephrologist and DaVita teammates deliver the best care possible.  A kidney doctor from Maryland, Dr. Weinstein is passionate about slowing the progression of chronic kidney disease in patients. This was such an outstanding conversation with one of the true innovators in technology and clinical care! Episode Bookmarks: 01:30 The importance of crossing the chasm of chronic kidney disease, a condition that impacts 37 million people in the U.S. 02:30 Introduction to Dr. Adam Weinstein, the Chief Medical Information Officer for DaVita Kidney Care. 03:30 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:30 Dr. Weinstein shares how his lived experiences and positive mindset have shaped his work as a nephrologist, healthcare executive, and technology innovator. 06:45 Treating kidney disease costs Medicare $130B – although CKD patients are 1% of the population, they account for over 7% of all Medicare spending! 08:30 An overview of the DaVita Integrated Kidney Care (IKC) program and how it produces solid results through data enablement and relationship building. 10:30 Integrated Kidney Care accomplished through people working in collaboration, predictive modeling, and population health management. 11:30 Facility versus At-Home Dialysis and the empowerment of patients through education and health literacy. 12:30 An overview of DaVita’s participation in value-based care payment models focused on CKD and ESKD. 14:30 Dr. Weinstein on how to bring scale to value-based payment innovation in kidney care. 16:00 The need for specialist and care team coordination that goes well beyond the office visit. 17:00 Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Models and how they provide financial and philosophical alignment for integrated care. 18:00 The challenges of including broader specialties and building an advanced data infrastructure in value-based kidney care. 19:00 The “clinical nebulous” that requires a longer runway for value...