Published by Healio

Based on its heavy dependence on Medicare funding, kidney care advocates who want to improve clinical pathways must be savvy at understanding the nuances of policy development and funding strategy on Capitol Hill. Kidney Care Partners, an advocacy group composed of kidney care providers, professional and patient associations, manufacturers and pharmaceutical companies, recently elected nephrologist Allen R. Nissenson, MD, FACP, FASN, FNKF, to a 2-year term as chairman. Nissenson serves as chief medical officer for DaVita Kidney Care and is emeritus professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, where he has served as director of the dialysis program and associate dean. Nissenson is also co-chair of KCP’s Quality Alliance. To get his start in the policy and payment environment in Washington, he was a Robert Wood Johnson Health Policy Fellow from 1994 to 1995 and worked in the office of the late Sen. Paul Wellstone. NN&I asked Nissenson about KCP’s makeup and priorities for the upcoming year.

NN&I: With your election, it marks consecutive terms of KCP chairs coming from the two largest provider organizations in the United States. Is this organization just about pushing the agenda for large dialysis organization?

Allen Nissenson, MD, FACP, FASN, FNKF: Not at all. My term does follow the tenure of Frank Maddux, MD, chief medical officer of Fresenius Medical Care, who was an excellent chair and is widely recognized as one of the leading thinkers in nephrology; but we both understand and represent the perspective of all members of the kidney care community including kidney care providers – large and small — as well as the broad cross-section of our coalition members. There are many member representatives within KCP who could and will serve in this leadership role and bring their expert perspective and talents to the table, so I am flattered and honored to have been chosen among my peers; but speaking as a physician who is intimately involved with the care needs of the patients — and who also happens to work for a provider — I feel I bring a unique familiarity with the care setting, the care team involved in the care, how reimbursement works, as well as the technologies, medicines, therapies and myriad co-morbidities associated with the patient.

From my perspective, I understand and respect all the roles and pieces that make up quality kidney care and make up the broad membership of KCP for that matter. I am happy to take the baton from a fellow physician and take KCP to the next level with our patient-centered agenda.

That being said, the purpose of KCP is to bring together a broad group of stakeholders whose common goal is to improve the lives of patients with kidney disease and maintain the sustained quality improvements that we have been able to achieve working together as a community. The agenda is set by KCP’s diverse membership and is a broad and inclusive one, and always has the goal of focusing on individuals with kidney disease and their care needs. I think the meaningful and measurable accomplishments and successes that KCP has been able to lead or contribute to in a significant way speaks for themselves.

While I am a chief medical officer for an international provider, I am also a practicing physician, researcher, an active member of my professional societies, including the American Society of Nephrology and the Renal Physicians Association, as well as co-chair of the Kidney Care Quality Alliance, where we have developed and introduced some thoughtful clinical recommendations to advance quality measurements, patient safety and outcomes. When I speak for KCP, I am speaking for the broader community and our collective priorities.

NN&I: How do you get consensus on setting priorities with such a diverse cast of characters? Can a patient organization and a pharmaceutical company have similar goals?

Nissenson: We have always operated under a “consensus majority” approach where the community won’t move forward with any decision unless we have a healthy majority. If we don’t have majority consensus, we take it back to the drawing board for more input and discussion or table it.

There is no question that each stakeholder group will have its own priority list of issues. That is inherently true for any health care sector, or industry, for that matter. This is not as difficult as it might seem since the unifying goal of improving the lives of kidney patients can be advanced in many ways. The key in my role as a consensus builder is to listen and understand each member’s priorities, and then find those issues that are high priority for the entire community; that are timely and topical, meaning what priorities best fit into the policy narrative taking place and what policies have legislative or administrative vehicles out there.

NN&I: Your exposure to the Washington political scene first came through your involvement with the Renal Physicians Association and later as a Robert Wood Johnson Health Policy Fellow in Senator Paul Wellstone’s office. What did you learn from that work? Do you think young nephrologists are interested in this kind of opportunity today?

Nissenson: Having this kind of exposure, which I didn’t get until the mid-point in my career, was invaluable to my subsequent interest and activities around public policy. It gave me an incredible networking opportunity not only with those dedicated individuals serving in government but also the health policy world which still serves me today. It gave me a clear understanding of the legislative and regulatory processes, and how to get things done in Washington and Baltimore, where patience and compromise are key. It also showed me how to be most effective when speaking with legislators and staffers, as well as regulators, to educate and persuade most effectively. Likewise, I learned how important facts and data are in making a strong case (that is the researcher in me talking now.)

I think there are a lot of opportunities for younger clinicians to get involved in policy and politics, especially when it comes to advocating for better patient care. Health care policy has always been a complicated and difficult terrain to navigate, so I understand the hesitation some might have to dipping their proverbial toes in the water; but once you consider the fact that decisions made in Washington can have a profound impact on our profession and the individuals we care for across the country, politics becomes hard to ignore. So we need more doctors and patient groups to be part of the conversation so policymakers get it right. They need to hear what we are seeing and experiencing from the front lines of care.

I hope my background as both a practicing nephrologist and a public policy advocate will encourage other doctors to get more involved in the political scene so they can become better patient advocates and we get better policy. Every voice counts. It really does.

NN&I: Important issues have come forth during the last few months: the discussion of new coverage rules for more frequent dialysis; legislation on integrated care networks and new approaches to fund [chronic kidney disease] CKD care, and concerns about transition to a new HHS chief and the fate of potential for health care reform. Plus, lingering questions about the role of third-party payers in paying insurance premiums. How do you see the next 12 months taking shape for renal care and KCP’s agenda?

Nissenson: KCP is an organization that constantly experiences transition and growth, as does all American health care and health policy today. The many issues mentioned above are ones of deep concern to KCP and ones we will be continuing to work aggressively to ensure that the best policies for kidney patients and the kidney care community are developed. In addition, we will be focusing on three key pillars over the next few years: 1) making sure the public, legislators and regulators understand the great accomplishment of the kidney care community on behalf of kidney patients during the past 2 decades; 2) expanding the KCP tent reaching out to the broader kidney care community, including those primarily focused on CKD and transplantation; and 3) focusing on the issue of innovation in kidney care — what are the barriers and how can we get more innovation in this field.

I’m pleased to say we have already had some major successes this year. The recent bipartisan Budget Act included several provisions that directly benefit kidney patients, such as expanded use of home dialysis therapy through telehealth services, expedited patient access to dialysis care at newly certified facilities, and extended authority for special needs plans. I’m looking forward over the next several months to continuing to advocate for our policy priorities, such as implementing the new kidney quality care agenda, supporting CMS’ coordinated care initiatives and ensuring individuals with kidney disease are able to access the same insurance options as everyone else.

NN&I: KCP has come out in support of new HHS chief Alex Azar. We’re transitioning from a doctor former HHS Secretary Tom Price, MD, running the country’s health plan to a lawyer. What do you like about Azar and what should the kidney community see as positives coming from his office?

Nissenson: The kidney community supports Azar’s nomination because we believe his past experiences navigating HHS make him well suited to implement the kinds of meaningful changes and improvements we need in our health care system and he is a person who bases decisions on data and results. In particular, we’re optimistic about the direction he’ll take with integrated and coordinated care, because that is something the field has needed for a long time. There are more than 30 million Americans who live with chronic kidney disease, many of whom also have other comorbidities like diabetes, circulatory issues, heart disease, hypertension and other comorbidities, which also means many different specialists, medicines and care settings, which is why we need to take a coordinated care approach to the patient with kidney disease.

Put simply, we need a modeled approach that improves coordination among all the various aspects of caring for a patient with kidney disease dialysis facilities, nephrologists and other health care professionals to work together to improve outcomes. I know existing coordinated care models have shown some promising results so far from recent government reports, so we’re interested to see where Secretary Azar is headed in this important area.

I think the kidney community is well positioned to work constructively with CMS and other stakeholders to make sure these models are designed appropriately and are supported by sufficient resources and are models that all providers — no matter the size or geographic location — can participate in.

NN&I: Health care, and how it is provided, is clearly changing. How do you want KCP to influence that process?

Nissenson: I agree, we are in a dynamic and exciting time in health care and kidney care in America. KCP is now positioned to take our work on behalf of the kidney care community to the next level; continuing to work with the Congress and CMS to ensure we are achieving the highest quality care will remain a high priority. In addition, we will look to broaden the appeal of KCP by focusing on research, innovation, CKD and transplantation. If we maintain our focus on always advocating for what is best for patients, we can do great things together in the years to come.

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