Nephrologists in the Driver's Seat for New Value-Based Partnerships

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Strive Health (Strive) has launched contracted partnership models under the Medicare program, Comprehensive Kidney Care Contracting (CKCC). Strive has partnered with 260 nephrology providers in five states in federally defined Kidney Contracting Entities (KCEs) to serve 8200 patients. Goals include delaying the progression of chronic kidney disease (CKD) to end stage kidney disease (ESKD) and supporting patients transitioning to dialysis and those going through the transplant process. Such efforts should reduce Medicare costs; a percentage of savings will return to the KCE partners.

Strive also announced that, to date, the company is managing 44,000 complex CKD and ESKD patients through

Strive Health (Strive) has launched contracted partnership models under the Medicare program, Comprehensive Kidney Care Contracting (CKCC). Strive has partnered with 260 nephrology providers in five states in federally defined Kidney Contracting Entities (KCEs) to serve 8200 patients. Goals include delaying the progression of chronic kidney disease (CKD) to end stage kidney disease (ESKD) and supporting patients transitioning to dialysis and those going through the transplant process. Such efforts should reduce Medicare costs; a percentage of savings will return to the KCE partners.

Strive also announced that, to date, the company is managing 44,000 complex CKD and ESKD patients through its various nephrology partnerships/direct-care arrangements, and a media release recapped several positive results. For example, the company's approach led to a 36% reduction in 30-day hospital readmissions, compared with a 3-year historical benchmark, for patients who enrolled in a Strive system accountable-care organization program.

With a history since 2018 of using specific analytics and last year's announcement of the Strive Care Partners models to improve kidney patient care, Strive Medical also impressed Nephrology Associates of Northern Illinois and Indiana (NANI) and became a strategic partner with its large multi-group practice. (NANI made an equity investment in Strive, joining New Enterprise Associates, Alphabet's CapitalG, and other venture capital investors.)

NANI nephrologist George Naratadam, DO, who is based in Chicago, said NANI was involved in earlier iterations with ESKD patients, but now the practice has a KCE partner and can retain help, for example, leveraging analytical data, ensuring smoother transitions when a patient leaves the hospital, and doing more work in the office setting with advanced CKD patients as opposed to on dialysis units. Likewise, Naratadam explains, “Depression screening also should be done, and we thought our patients would be best served if we partnered with another organization that specializes in population health.”

Strive is embedding complete-care resources within NANI practices, such as preventive care, specialized clinical programs, data integration and analytics, and management of risk contracts. After 6 months of examining its systems and 6 months of working with Strive, the KCE has been operating for 1 month at the time of reporting. NANI is still learning about how best to use the analytic data, but Naratadam said the program already has helped NANI focus on patients with high utilization rates that drive up costs (e.g., patients at higher risk for readmissions or unscreened for existing depression).

The Strive KCEs are founded on the idea of value-based medicine. Strive Senior Vice President of Provider Solutions Ben Kuhn defines value-based care as contracts that “compensate providers for good outcomes rather than the volume of services they deliver.” All Strive-partnered KCEs are taking responsibility for the total cost and quality of care for their patients (known as the “Global Option”), taking risk away from Medicare; savings await for effective care. KCEs can contract with a choice of three options, including a safer, graduated risk option, Kuhn said.

Naratadam explained that NANI is currently focusing on finding more opportunities for patient education, including a video for patients, and discussions with a practice or Strive nurse practitioner. He anecdotally recounts how the KCE also is embracing care coordination. After patients on dialysis experienced problems on weekends, he noted, “We got a very nice report on my region and our bigger groups’ access data, and we saw based on the claims data exactly where people had gone, what the cost was, and how they were admitted…. I think it was an eye opener.”

The KCE care coordinator, provided by Strive, can arrange rides “to get a patient 10 miles more than [he or she] would have gotten on [his or her] own, to a dialysis center for assistance, get de-clotted before the weekend, and not get admitted,” Naratadam says. He also explained that with the new partnership, already one patient has been able to quickly obtain secondary health insurance, the issue that was holding up a kidney transplant. The practice relied on a Strive social worker for insurance assistance and a care coordinator to work with the transplant center.

Kuhn said the common theme across Strive's KCEs is prevention—of progression to kidney failure, of hospitalization, or of unplanned or unexpected crash onto dialysis.

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