Ep 36 – How to Win in Value-Based Kidney Care, with Robert Sepucha

What this episode covers

Chronic kidney disease kills more people than breast or prostate cancer each year – it’s the 9th leading cause of death but you won’t see NFL players wearing socks and gloves to increase awareness. Thirty-seven million people in the U.S., or 15 percent of adults, are impacted by CKD, and around 90 percent of those with the disease don’t even know they have it! Treating kidney disease costs the Medicare program $130B and although patients with kidney failure account for only one percent of the Medicare population, they are responsible for over seven percent of all Medicare spending. Over the last 40-50 years, kidney care has experienced significantly less transformation than other areas like diabetes, cardiology, cancer, and HIV/AIDS. We have been failing in kidney care for far too long, and instead of focusing just on dialysis, we need to realize that kidney disease is more than just ESRD, and there is way more to ESRD than just in-center dialysis. This historic stagnation in kidney care with a large population now in crisis is a hugely abundant opportunity for innovative companies like Cricket Health to come in and change the game. In this week’s episode, we are joined by Bobby Sepucha, CEO of Cricket Health, a specialty care management company leading the way in the Value-based kidney care space. National Kidney Month is the right time to discuss how we can win this Race to Value with integrated nephrology and dialysis care for people with Chronic Kidney Disease and End Stage Renal Disease. Episode Bookmarks: 02:00 37 million people in the U.S., or 15 percent of adults, are impacted by CKD, and around 90 percent of those with the disease don’t even know they have it! 02:15 Medicare pays well over $100 billion for people with all stages of renal disease, which was nearly 20 percent of all Medicare spending last year. 02:45 While just one percent of Medicare beneficiaries have kidney failure, kidney failure accounts for over seven percent of all Medicare spending! 05:35 The system is designed to fail patients with chronic kidney disease 07:45 How the 1972 Medicare enrollment eligibility provision for ESRD patients created an unintended consequence of earlier stage CKD patients getting neglected 08:09 President Trump’s Executive Order on Advancing American Kidney Health (July 2019) 08:35 Bobby recalls his work with CMS and Congress to bring the ESRD Seamless Care Organization (ESCO) alternative payment model into fruition 09:00 “Unless we go upstream and start engaging patients prior to kidney failure, success in value-based kidney care will be limited.” 09:30 40% annualized mortality rate for dialysis patients can only be addressed by upstream CKD intervention 09:40 The new Kidney Care Choices (KCC) and the ESRD Treatment Choices (ETC) payment models 11:50 “Only 12% of ESRD patients today in America dialyze at home – that lags other nations to such an alarming degree.” 12:15 “If you were going to design the worst imaginable healthcare delivery system for kidney patients, you’d come up with the one we have here in America. Costs are astronomical, outcomes are terrible, mortality rates are through the roof, everyone is dialyzing in a center instead of home…it just doesn’t make any sense.” 12:55 60-65% of ESRD patients “crash” into dialysis with an ER visit 14:00 Cricket’s model for upstream CKD intervention 15:00 “Getting patients to dialyze at home is a multifactorial problem.” 16:15 The overlap of nephrology and palliative care 18:00 Telehealth is the silver lining to the pandemic 18:30 A patient story about the success of transitioning to home-based dialysis