Advancing American Kidney Health is already affecting the business strategies of U.S. dialysis organizations of all sizes, and DaVita Kidney Care executives say that are poised to lead this industry-wide push. DaVita reported in July that its PD and home hemodialysis programs were growing at four times the rate of its in-center treatment options.
“We committed to a focus on home dialysis before the executive order came out,” Martin Schreiber, MD, chief medical officer for DaVita Home Modalities, told Healio/Nephrology.
Although DaVita is the largest provider of home dialysis therapy in the United States, the large dialysis organization (LDO) is committed to increasing the percentage of patients choosing home care; 86% to 88% currently use in-center treatment, according to Schreiber.
Make home care accessible
“I’ve always felt when I was in active practice that [home therapy] increased the independence of the patient and that it improved their quality of life,” Schreiber said. “Patients told me that when I saw them for clinic visits.”
Making sure patients know their options, as well as the benefits and drawbacks of each, is an essential part of DaVita’s commitment to patient choice, he added.
Schreiber agreed with the leaders of other kidney care organizations that the main regulatory barriers the initiative addresses are related to cost, but he added, “There are a number of non-regulatory barriers that have impeded growth of home [kidney treatment] and that we need to solve as we move forward.” Education is a major issue, Schreiber said, for both clinicians and patients. Nephrologists are not adequately trained in home modalities during fellowship training, and support staff often are unaware of the advantages offered by home treatment, he said. Additionally, he said that for patients, “Education is paramount. Every patient [should have] an opportunity to be educated about their modalities and reach an informed choice.”
DaVita reported in July that its PD and home hemodialysis programs were growing at four times the rate of its in-center treatment options.
Source: Adobe Stock
Schreiber said even when education is available for patients, it is not always feasible. Issues such as cost of travel for training and home modifications needed to prepare for PD or home hemodialysis (HHD) can disincentivize patients from these options.
“The main concerns relate to ensuring that every single patient is informed ... and that we somehow work with the government to figure out how we recognize some of the challenges patients face that relate to training,” Schreiber said.
Evolve with technology
DaVita is working to solve some of these problems through the use of technology. Its Kidney Smart program, launched in 2012, has reached more than 160,000 patients and now conducts more than 20,000 classes each year. Schreiber said DaVita continues to explore the ways in which technology can aid in educating both patients and clinicians. The organization is rolling out a modality choice program so that any staff who come into contact with patients will “understand the quality of life and clinical benefits for a patient managing their disease at home,” he said.
Kidney Smart is just one of a number of tech-focused programs DaVita utilizes, both to increase its reach and increase the options it offers for different learning styles and preferences.
“We continue to look at programs that improve the way we educate both staff and patients,” Schreiber said.
The Home Dialysis Connect suite of technologies includes home remote monitoring via Bluetooth, virtual appointments (patients can opt for two of three visits per quarter to be conducted virtually), a mobile app, online courses and even the use of artificial intelligence to identify high-risk patients. Schreiber said more than 14,000 patients have used DaVita’s home remote monitoring. Technology is “critically important to optimizing outcomes for home patients,” Schreiber said. The goal of DaVita’s virtual offerings, he explained, is to “increase connectivity ... while decreasing isolation.”
These offerings are all part of DaVita’s goal of improving patient outcomes, he added.
“DaVita is evolving into an integrated kidney care company, so we’re not just a dialysis company anymore,” he said. – by Amanda Alexander
Disclosures: Schreiber reports that he is chief medical officer for Home Modalities at DaVita.