Chronic Kidney Disease: Exploring Value-Based Healthcare as a Potential Viable Solution

Abstract

Background: Increasing healthcare expenditures have triggered a trend from volume to value by linking patient outcome to costs. This concept first described as value-based healthcare (VBHC) by Michael Porter is especially applicable for chronic conditions. This article aims to explore the applicability of the VBHC framework to the chronic kidney disease (CKD) care area. Methods: The 4 dimensions of VBHC (measure value; set and communicate value benchmarking; coordinate care; payment to reward value-add) were explored for the CKD care area. Available data was reviewed focusing on CKD initiatives in Europe to assess to what extent each of the 4 dimensions of VBHC have been applied in practice. Results: Translating VBHC into value-based renal care (VBRC) seems to be initiated to a limited extent in European health systems. In most cases not all dimensions of VBHC have been utilized in the renal care initiatives. Conclusion: The translation of VBHC into VBRC is possible and even desirable if an optimal treatment pathway for CKD patients could be achieved. This would require an organizational change in health system set up and should include a strategy focusing on full care responsibility. The patient outcome perspective and health economic analysis need to be the centre of attention.

Redefining value: a discourse analysis on value-based health care

“…The conceptual ambiguity surrounding VBHC is conspicuously evident in academic publications. To some scholars, VBHC is primarily a 'management concept' [1] or a 'management innovation' [2,6]; to others, it is basically a business 'strategy' for both providers and payers [7]; others see it as a 'governance regime' [3], or a 'health policy framework to integrated care' [8]. Additionally, while the importance of outcome measurements for VBHC is generally well established, the range of its utility remains debated.…”

Informed decision-making in delivery of dialysis: combining clinical outcomes with sustainability

“…The challenge of applying this framework to the renal setting (value-based renal care) is that CKD itself is caused by other major chronic conditions such as diabetes and hypertension, but also directly contributes to cardiovascular disease, the major cause of death in CKD and dialysis patients [ 22 ]. Additionally, as CKD is an extraordinarily complex set of physiological conditions intricately linked to numerous metabolic disorders and perturbations, measurement of ‘meaningful outcomes’ is extremely challenging.…”

“…patients, providers, regulators and payers) [ 36 ]. Figure 1 presents the main categories of the stakeholders whose collective participation is required at different levels of the care delivery processes [ 22 , 27 ]. Each stakeholder has a vested interest in the value agenda and with conflicting expectations and motivations (or motives) between each other, progress is only achieved if the multiple blocs of the delivery system are advanced as mutually reinforcing entities.…”

Kidney supportive care: an update of the current state of the art of palliative care in CKD patients

“…The IPOS-Renal, with a one-week recall, 49 and ESAS-r: Renal, which evaluates the present symptoms 44 , are recommended tools for routine screening at each consultation 50 . Recently, the International Consortium for Health Outcomes Measurement (ICHOM), in the CKD standard set for value-based health care (VBHC), recommended PROMs use like PROMIS-Global Health or SF-36v2 every 6 months 51,52 . Table 3 summarizes the pharmacological treatment of the most common symptoms in CKD.…”