HJBR Jul/Aug 2024

HEALTHCARE JOURNAL OF BATON ROUGE I  JUL / AUG 2024 31 roles within the kidney care industry at Gam- bro and DaVita, prior to co-founding Strive in 2018. Since then, he has been named an EY Entrepreneur of the Year in 2021 and Denver Business Journal’s Most Admired CEO in 2023. Calling their 700 employees “Strivers,” Strive has been recognized multiple times as a best place to work. These accolades become pos- sible when disruptive innovators adopt busi- ness models that enable highly motivated people to completely rethink how health- care should ideally be delivered to those in need in the pursuit of purpose-driven work. How does Strive Health drive their outcomes? First, it is by understanding that improving the health of a population is the summation of im- proving outcomes first at an individual, highly personalized level. Using their trademarked CareMultiplier information technology and advanced analytics platform, they aggregate disparate sources of data to generate holistic insights into their population and identify their most at-risk patients. They can then customize solutions for an N of 1 using a team-based ap- proach that utilizes different domains of knowl- edge. Realizing that nephrologists should help lead and coach the team, but that 1) they are in short supply, and 2) a single nephrolo- gist cannot accomplish all the tasks necessary that each patient requires, they are able to use real-time insights from CareMultiplier to allow their care team to develop a personal- ized care approach and individualized care plan for each patient. Calling their care team “Kidney Heroes,” the team acts as an exten- sion of the nephrologist, who leads the over- all management of a patient’s care. The team is comprised of advanced practice providers, nurses, care managers, social workers, and di- etitians, each having a crucial role to play de- pending on each patient’s unique needs. Also part of the team is a medical director who is held accountable for the outcomes of the over- all care model. Kidney Heroes are embedded into local markets and are responsible for fully engaging in their patients’ lives, helping man- age their comorbidities, providing support for social determinants of health (including low health literacy and impaired self-efficacy), offering dietary guidance that takes into con- sideration local cultural patterns, values, and providers and traditional health systems who still hold such a fixed mindset should look at themselves more carefully in the mirror as they fail to measure and improve health literacy when attempting to educate patients about the nuances of complex care required for ESKD patients, such as a low sodium diet, while also failing to invest in care management support that helps reduce hospital admissions, or fail to invest in advanced analytics capabilities to identify the highest risk cohort of patients who are most prone to future admission. These traditional health systems are quick to assert that Medicare reimbursement fails to cover their total cost of care for these patients, all the while ignoring the potential to innovate by figuring out how to generate a profit mar- gin on these patients by doing something almost unheard of in traditional healthcare — measuring and improving health outcomes. Fortunately, for patients who suffer from ESKD, there are some innovators out there who are quietly disrupting the system to cre- ate a better future. Strive Health, Monogram Health, and even some “systems that deliver health” (like my own health system) are work- ing on new solutions that leverage the unique economics of Medicare Advantage to improve care for patients with ESKD. For purposes of this discussion, let’s take the example of Strive Health. Co-founded and led by Chris Riopelle, Strive Health’s innovative clinical model has improved care quality and reduced hospital admissions for their patients by nearly 50%, re- admissions by 30%, and total cost of care by 20%. Basically, they utilize a reinvented busi- ness model that capitalizes on the risk-adjusted population-based payment made possible un- der the unique financing of Medicare Advan- tage contracts to generate their profit margin by doing what is best for patients — keeping them as healthy as possible by painstakingly re- ducing potential complications from ESKD. By understanding and correcting many of the dys- functions inherent in the transactional financing of traditional Medicare, Strive Health generates their profit margin by improving their patients’ health and reducing avoidable utilization. Chris learned firsthand about some of the dysfunc- tions afflicting healthcare and persons who suf- fer from advanced CKD and ESKD in his prior In the last article, we began a discussion about changing the management of chronic kidney disease (CKD) within the context of a flawed healthcare payment/reimbursement environ- ment that is failing to keep pace with health- care delivery’s ability to dramatically improve health outcomes for the patients we serve. Systems that deliver health will nevertheless continue to innovate in how we better deliver care because it is what is right for our patients, while traditional health systems and payers will continue to hold onto their outmoded business models, attempting to stay relevant in a future of value-based healthcare that cannot come fast enough. In part B of this second article on CKD, we will begin by illustrating how business model innovation focuses on preventing hospi- tal emergency room visits, admissions, readmis- sions, and other complications for patients who suffer from end stage kidney disease. But we also cast a vision of a hopeful future where the incidence and prevalence of end stage kidney disease becomes drastically reduced, which is now not only possible, but imminently realistic. Striving for Innovation in ESKD End stage kidney disease (ESKD) is the fifth and final stage of CKD, when a person’s kidneys are no longer able to function well enough to sustain life without dialysis or kidney transplant. ESKD is also one of the most expensive chronic conditions, and therefore it is of no surprise that this condition is an ideal target for those entrepreneurs with a growth mindset focused on disruptive innovation. The average annual total cost of care for a person with ESKD can easily exceed $80,000 or even $100,000 per year. Most of this cost is related to the seem- ingly inevitable complications of ESKD, such as the costs of hospitalizations for volume overload or sepsis. Most importantly, though, dependence on dialysis can be a miserable ex- perience for the patients who suffer from ESKD. The transaction-based financing of traditional Medicare perpetuates many of these costs by failing to hold providers accountable for the total cost of care for these patients. It is easy to label a patient as “noncompliant” for fail- ing to adhere to a low sodium diet and then blame that patient when they get admitted for volume overload from excessive salt intake. But