Dialysis Company CEO on Ways to Improve Chronic Care

Marie Thibault

Medical treatments for patients with a chronic disease make up 86% of America's health care costs, according to the CDC. Yet despite all that spending, most experts agree that chronic care is far from perfect. Chronic diseases are the cause of 70% of deaths each year and there is much more that could be done to ensure coordinated care that allows these patients to receive the treatments they need and lead as normal a life as possible.

As CEO of Fresenius Medical Care North America, one of the top 10 medical device companies in the world, chronic care is front of mind for Ron Kuerbitz. Fresenius has more than 2,200 dialysis facilities, as well as urgent care centers, outpatient cardiac and vascular labs, and post-acute providers. "Patients living with chronic conditions have very special needs. They have different treatment goals and they're not, for the most part, looking for a cure. We're looking to help these patients live their lives," says Kuerbitz. 

Fresenius recently published findings from its 2015 Health Indicator survey on chronic care that showed a striking mismatch between the overwhelming belief that chronic care should be a top priority and the reality of chronic care today. The survey, which gathered views from 1,000 Americans and more than 280 physicians, found that 99% of physicians believe chronic care should be a priority but only 45% of physicians say it is a priority now. 

One of the reasons for this disparity is not enough coordination between providers. In the survey, 55% of physicians said that insufficient coordination among other doctors is a major hurdles to adequate chronic care. Kuerbitz says, "There's some concern that coordinating among providers is a difficult task. More complex, there's more friction in that communication than there really should be."

What's more, chronic care patients feel that the care they receive falls short in helping them retain quality of life. About 40% of patients and family members say the health care system does not effectively help them with psychological or psychosocial care and 40% of physicians agree, according to the survey.

What could be the answer? The survey points to the benefits of integrated networks, since two-thirds of doctors think they could deliver more effective treatments with integrated care networks and 86% of the surveyed general population think coordinated treatment is important.

Kuerbitz, who participated in the Chronic Care Forum organized by Fresenius and FT Live earlier this month, believes that companies, providers, regional health systems, and payers all have a part to play. He notes that the participant discussion at the event acknowledged: 

Providers can begin to tackle the issue of chronic care themselves, Kuerbitz says. He points out that Fresenius, a vertically integrated company, has a nationwide network focused on patients with chronic renal disease. The scale of this network allows Fresenius to concentrate on addressing areas of high costs and to use resources that can improve patient clinical outcomes and quality of life.

"But we can't do it by ourselves . . . we need to build bridges to regional health systems . . . to payers that are organizing the financial care for the patient . . . that's where the dialogue comes in," says Kuerbitz. He adds that payers and the government can lower the barriers to this care coordination and bring in incentives for cooperation between regional/primary health systems and chronic care systems.

Kuerbitz admits there is still room for improvement in chronic care for dialysis patients. This includes opportunities to address patients' clinical and psychosocial needs, possibly through partnerships, and post-acute management and hospital coordination, since there is a 33-35% average readmission rate among the dialysis patient population. "We think there must be inefficiency there, there must be an opportunity to reduce that mid-30% readmission rate and improve outcomes for patients," he says.

Fresenius has seen concrete benefits from its network and access to large volumes of data. Kuerbitz relates an example where the company was able to analyze patient data and use predictive analysis to determine which dialysis patients might end up in the hospital. Care teams could then increase their focus on these high-risk patients and with the help of new technology, these caregivers found that these specific patients consistently had too much fluid in their bodies and that the target dry weight (after dialysis treatment) was being overestimated. Knowledge of this problem and attention to the factors causing it resulted in Fresenius being able to cut fluid overload admissions by 50% in these high-risk patients, Kuerbitz says. "It was a huge win that really highlights the benefits of scale and focus, the system that allows us to roll out new processes, and a technology focus that allows us to enable that care system to get data that they could never get before," he says.

Marie Thibault is the associate editor at MD+DI. Reach her at [email protected] and on Twitter @medtechmarie. 

[Image courtesy of OLOVEDOG/FREEDIGITALPHOTOS.NET]