Why Kidney Care’s Biggest Investment Wave Hasn’t Moved Hospital Costs
The problem may not be the investment. It may be the target of the intervention.
The problem may not be the investment. It may be the target of the intervention.
The future of value-based care will hinge on empowering providers, and specialists in particular, with the data and strategic partnerships to proactively manage patient health beyond traditional clinical settings.
Lakshmi Halasyamani, chief clinical officer at Endeavor Health, thinks value-based care isn't really about payment models. To her, this work centers on understanding patients' clinical, social and financial circumstances well enough to make care plans that actually work for their lives.
VBC aligns reimbursements to outcomes, emphasizing the quality and effectiveness, not quantity, of healthcare activities. But the same cost constraints driving interest in VBC can also turn it into a liability.
The next evolution in digital health is layering intelligent orchestration on top of the EHR to activate care in real time. It’s a platform plus orchestration layer, powered by AI and designed for action.
The clinicians working in this system are often deeply committed to their patients. The problem is the system itself which rewards the quantity of time and largely ignores the quality of the treatment’s impact.
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.
Healthcare leaders can’t tell whether value-based care and Medicare Advantage are truly lowering costs. Some see promise in these models and ongoing innovations, while others say the programs haven’t delivered measurable savings and point to direct contracting as a more transparent way to control spending.
Leaders must resist the urge to replicate urban models that do not translate well to rural contexts. Instead, they should design solutions that are built for rural communities, grounded in local insight and enabled by scalable capabilities.
As AI-enabled coding increasingly adjudicates and reimburses claims on the first pass, often at higher levels, payers face a growing challenge: traditional cost-containment mechanisms are unable to keep pace.
VBC models deliver significant benefits for CKD management by coordinating medical, behavioral, and social support through multidisciplinary teams. This approach enables providers to personalize care, address barriers to access, and use data-driven strategies to identify and prioritize high-risk patients.
A unified workflow for all referrals, resulting in fewer clicks and less confusion, means provider matching can be conducted based on specialty, location, insurance, and real-time availability, for an easier track to the right provider, not just any provider.
With new therapies being approved, and many others in the pipeline, they raise a critical question: Is our healthcare system prepared to deliver them effectively and sustainably?