The American Society of Nephrology (ASN) and other members of the kidney community met with Health and Human Services (HHS) Secretary Alex M. Azar II and other top HHS officials in a roundtable on Friday, February 1 to discuss value-based kidney care transformation.

During the meeting, Secretary Azar, Centers for Medicare and Medicaid Innovation (CMMI) and Senior Advisor to the Secretary for Value-based Transformation and Innovation Director Adam Boehler, Assistant Secretary for Health Admiral Brett P. Giroir, MD, and Chief Technology Officer Ed Simcox, underscored the administration’s interest in improving the lives of people with kidney diseases, including efforts to increase access to transplantation. ASN underscored the society’s gratitude for their interest in transforming kidney care delivery for the 40 million Americans with kidney diseases and, together with the other participants, a strong willingness to work collaboratively to achieve shared goals.

The conversation covered a wide range of topics, and near the top of ASN’s list was reiterating the society’s interest in CMMI developing a comprehensive kidney care model to test, building on lessons learned from its ESRD Seamless Care Organization (ESCO) model focused on dialysis care. ASN is strongly supportive of testing a model that breaks down the silos between advanced kidney disease, kidney failure, and transplant—and which has an explicit emphasis on promoting use of home dialysis and transplantation. Such a model, ASN noted, would be most successful by setting a short list of improved patient outcomes it seeks, and giving nephrologists more latitude and flexibility than in the current system to determine how best to achieve those improvements at their local level.

In the meeting, and in additional communications with other CMMI leaders, the society also emphasized that testing greater physician flexibility for how nephrologists provide care to in-center hemodialysis patients, as well as creating more incentives to focus on non-dialysis kidney care, could yield significant benefits for patients and help to slow or prevent the progression to kidney failure. This goal could be accomplished either through expanding the current ESCO program or by developing a voluntary nephrologist- or nephrology practice-led model, provided financial risk is appropriately limited.

Another area of focus for ASN opportunities to foster increased transplantation be increasing the supply of organs. As the healthcare system drives towards more transplantation as an explicit goal in value-based care models, another lever to achieve that goal is to improve organ procurement efforts. Strengthening the quality of the data that is used to assess and the metrics used to evaluate these efforts is one such potential opportunity.

ASN also thanked the administration for its recent proposal to revise the one-year outcome metrics used to evaluate transplant centers and discussed the need to ensure lifetime immunosuppressive drug coverage. One way the society noted HHS could support this goal is to ensure Congress receives timely data about the patient population that would benefit, so lawmakers have accurate information to make this change on the legislative level. If HHS were to identify a regulatory approach to providing lifetime coverage, such as through waivers for continued eligibility in a Centers for Medicare and Medicaid Innovation model, ASN would also be supportive.

Other stakeholders participating in the roundtable were the American Association of Kidney Patients, the Renal Physicians Association, the National Kidney Foundation, and DCI.

ASN thanked HHS for its partnership in establishing in KidneyX, and specifically highlighted Mr. Simcox’s leadership in support of the initiative. KidneyX, a public-private partnership between ASN and HHS, aims to accelerate innovation in the prevention, diagnosis, and treatment of kidney diseases through a series of prize competitions.