Value based care in nephrology: the Kidney Care Choices Model and other Reforms

The Advancing American Kidney Health (AAKH) initiative has reinvigorated the focus on improving the care of patients with advanced chronic kidney disease. Multiple interventions have been planned, with focus on education campaigns for both clinicians and patients, delaying the progression of kidney disease and improving utilization of home dialysis modalities and kidney transplantation. Value-based care models for patients with advanced kidney disease are being rolled out, with the ESRD treatment choices model starting in January 2021, and the Kidney Care choices model planned to start in January 2022. There is increasing emphasis on the role of the nephrologist as the "captain of the ship", leading efforts in care coordination as physician leaders. The transplant reforms have focused on changes to organ procurement organizations aiming to increase availability of organs, as well as transplants performed, both deceased donor as well as living donor, and removing financial disincentives from live organ donation. The American Society of Nephrology (ASN) and the National Kidney Foundation (NKF) are partnering with the Department of Health and Human Services to develop educational material for clinicians and patients. In this review, we discuss these reforms, as well as potential challenges that have risen, and potential solutions, with emphasis on the Kidney Care Choices model.