Value‑based care has long promised better outcomes at lower cost. The real question was whether that promise could hold in the most complex, high‑need corners of healthcare. Kidney care provides the answer.
With high medical complexity, concentrated costs, and frequent care transitions, it is one of the most demanding environments for integrated care—and one of the clearest proof points. If value‑based care can work here, it offers a credible blueprint for the rest of healthcare.
For years, the central question was whether value-based care could work at all. Today, evidence from kidney care moves us beyond that debate. The more urgent questions are who can scale these models effectively and whether the system will sustain what’s working long enough for it to endure.
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Tangible results signaling momentum
Progress in integrating the American healthcare system is inherently slow — especially in kidney care, where nearly 90% of patients rely on government insurance and reform depends on sustained collaboration between providers and the Centers for Medicare & Medicaid Services (CMS). That collaboration is now producing measurable results.
Data from the Center for Medicare & Medicaid Innovation (CMMI) on Comprehensive Kidney Care Contracting (CKCC), the largest value‑based kidney care demonstration — shows that coordinated, patient-centered models can deliver both clinical and economic gains.
Since CKCC began in 2022, participants in the model have achieved significant financial and clinical progress, including early shared savings and earlier‑than‑expected profitability in integrated care programs. These results demonstrate that even for one of healthcare’s most complex populations, better outcomes and financial sustainability can reinforce one another.
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Clinical excellence as an economic engine
What drives financial stability at scale?
Not financial engineering or favorable risk selection. The answer is a relentless focus on improving health.
Traditional fee‑for‑service care fragments patients across specialties, settings, and incentives. A single patient may see multiple physicians with limited coordination among them, often receiving care only after clinical deterioration. The result is reactive, episodic treatment that drives unnecessary utilization, avoidable hospitalizations, and higher total cost of care.
Value‑based care replaces that fragmentation with integrated, team‑based models. Interdisciplinary care teams enable earlier intervention, better planning, and fewer avoidable crises, ultimately reducing preventable hospitalizations, improving the patient experience, and stabilizing total cost of care.
From pilot to permanency
This approach is no longer theoretical. As of 2023, the CKCC model was comprised of over 100 kidney contracting entities with thousands of nephrology professionals and hundreds of associated providers. Kidney care has moved beyond pilots to a real‑world operating model.
With that scale comes both responsibility and opportunity. The kidney community has developed a roadmap for managing complex chronic disease that can inform care across specialties. But sustaining progress requires moving from time‑limited demonstrations to durable policy.
CKCC represents one of CMS’s strongest opportunities to lock in long‑term savings while continuing to improve outcomes for patient outcomes. Extending the model — or making it permanent — would allow providers and policymakers to build on years of investment, infrastructure, partnerships, and trust.
Resetting the system just as results are materializing risks interrupting momentum and undermining gains patients are already experiencing through coordinated care.
This is the transformation value‑based care has long promised: better outcomes, lower costs, and a better experience for patients. Kidney care is proving it’s possible — if we treat success not as an endpoint, but as a foundation to build on.
The path forward is clear: invest in the infrastructure, partnerships, and policies that enable integrated, whole-person care to function as the sustainable operating model for the future of American healthcare.
Photo: Hong Li, Getty Images
Misha Palecek is Chief Transformation Officer for DaVita’s U.S. Kidney Care business, where he leads growth through value-based care partnerships, mergers and acquisitions, joint ventures, and care delivery innovation.
Since joining DaVita in 2005, Misha has held senior leadership roles across strategy, operations, and transformation. His experience includes regional and divisional operations, oversight of more than 120 sites of care, and leadership of DaVita’s home dialysis strategy. He later led Paladina Health, a DaVita‑affiliated primary care startup, and served as president of ABQ Health Partners, a physician‑led multispecialty group in New Mexico. In his current role, he leads enterprise transformation efforts focused on advancing value‑based population health across health systems and physician organizations. He also founded DaVita’s Village Green program. Misha holds an MBA and a B.A. from Stanford University and lives in the San Francisco Bay Area with his family.
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