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

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

19:55 The appalling lack of kidney care innovation over the last 40-50 years

22:20 The obesity epidemic and exploding kidney care costs over the last few decades

23:00 Working with payers for a more holistic approach to value-based kidney care

23:45 Payer goals: 1) reduce CKD hospital utilization prior to onset of dialysis, 2) address transition cost spike from CKD to ESRD, 3) reduce ESRD hospitalizations

24:50 Cricket’s goal to deliver the “right care to the right patient with the right team at the right time and place”

25:20 Predictive modeling algorithms for early CKD detection and risk stratification

26:20 Fostering intentional patient relationships based on trust

27:00 Leveraging virtual platforms in CKD patient engagement

30:00 The importance of Primary Care in early detection of CKD and referral guidelines between primary care and nephrology

31:30 Filling the gaps in primary care with AI

32:00 “The ideal kidney care delivery system is primary care physicians taking the lead in treatment of patients with early stage kidney disease.”

34:00 Evidence-based pathways in value-based kidney care

35:30 Cricket Health’s partnership with Baylor Scott & White

37:15 “There might not have been a better time to be an investor or an entrepreneur in the kidney space, it is a perfect confluence of events to make some intelligent bets” (Bryan Sivak, KP Ventures)

40:00 Partnership with physicians, systems and payers and the sharing of financial risk

43:40 CKD as a microcosm of everything that is broken in the U.S. healthcare system

45:30 The story of the founding of Cricket Health

46:30 Patient consumerism and health literacy in kidney care

48:00 Recreating the “digital sidewalks” for patients in accessing education about their disease

48:30 Disproportionate burden of CKD and disparities in outcomes in the African American population

51:00 Designing tech-enabled, multi-modal population health deployments to address health equity challenges

54:30 Parting words on how to win the Race to Value in kidney care