A Transplant-Inclusive Value-Based Kidney Care Payment Model.

Area of Science:

• Health Economics
• Nephrology
• Healthcare Policy

Background:

• Value-based care (VBC) models are increasingly adopted in the United States for kidney care, aiming to improve quality and reduce costs.
• Current VBC models for kidney disease are set to continue through 2026, necessitating future planning for comprehensive care.
• There is a need to integrate kidney transplantation more effectively into VBC frameworks.

Purpose of the Study:

• To propose a novel transplant-inclusive value-based care (TIVBC) model for patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD).
• To outline a risk-based reimbursement structure for key stages of the kidney transplant pathway.
• To address challenges and suggest future directions for implementing an end-to-end TIVBC model.

Main Methods:

• The proposed TIVBC model is structured as an episode-of-care approach.
• Risk-based reimbursement is designed for distinct phases: referral/evaluation/waitlisting (REW), immediate post-transplant hospitalization (0-180 days), and long-term graft survival.
• Discussion includes challenges such as organ acquisition costs and quality metric adjustments.

Main Results:

• The proposed TIVBC model offers a framework for integrating kidney transplantation into value-based reimbursement.
• Identifies key areas for risk adjustment and cost prediction necessary for model development.
• Highlights potential challenges and areas for further research and refinement.

Conclusions:

• The proposed TIVBC model provides a supplementary approach to current kidney VBC models.
• Successful implementation requires addressing organ acquisition costs and refining quality metrics.
• Further development in risk-adjustment and cost-prediction is crucial for a comprehensive TIVBC model.