Transforming Kidney Care with Martha Wofford and David Roer of Davita was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best audio automated transcription service in 2020. Our automated transcription algorithms works with many of the popular audio file formats.
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Saul Marquez:
Welcome back to the podcast. Saul Marquez is here, and today I have the privilege of hosting two distinguished guests. First, I want to introduce Martha Wofford. She’s a group vice president at DaVita Integrated Kidney Care. Martha is a visionary leader in Value-Based Care, serving and strategic and operational roles that focus on revolutionizing patient care and experience. During her tenure, the commercial business for DaVita Integrated Kidney Care has grown by 50 percent. Prior to DaVita, she held various leadership roles at Aetna for nearly a decade in both Medicare and commercial businesses. Martha received her MBA from the Kellogg School of Management from Northwestern University and a B.A. in history from Swarthmore College. My second distinguished guest is Dr. David Roer. Dr. Roer serves as the V.P. for Medical Affairs for Integrated Care and the National Group Medical Director for DaVita. He also serves on the board of directors at Renal Physician Association. He served as co-chair of the AA Am I Renal Disease and Detoxification Committee. He previously served as chief of Nephrology, Chief of Staff and chair of the Medical Executive Committee. Medical Director of Patient Safety and Clinical Quality. Chairman of the Peer Review Oversight Committee. And Chair of the Ethics Committee at St. Mary’s Hospital. Prior to starting at DaVita, Dr. Roer was the managing partner of Nephrology and Hypertension Associates in Waterbury, Connecticut, for 30 years.
Saul Marquez:
Dr. Roer completed his nephrology and hypertension training at Yale School of Medicine and was an associate clinical professor of medicine. So with these two distinguished guests here today, I’m so excited to touch on the value of value-based care and what it means for kidney patients. What does it mean for provider organizations and payers involved? And it’s such a privilege to have both of you here today. Thanks for joining me.
Martha Wofford:
Thanks for having us.
R. David Roer:
Thanks Saul.
Saul Marquez:
Absolutely. So is there anything I missed in the introduction that you’d like to share with the listeners?
Martha Wofford:
No, that was great.
R. David Roer:
No, I think you covered it all.
Saul Marquez:
Awesome. Well, both of you are very seasoned and experts in the field. And I’m truly privileged to be with you here today. And the listeners are excited, too. So, Dr. Roer, why did you decide to get into the medical sector?
R. David Roer:
Well, it’s an interesting story. You know, after studying the science as an undergraduate school, I then went on to do some graduate studies in clinical psychology. And I became interested in addiction medicine and worked in a method on maintenance clinic. It was through that experience that I met a mentor who encouraged me to seek a career in medicine. So I was still unsure what I wanted to do. I decided to hike the Appalachian Trail and it was while on that five-month track I decided to go to medical school and my mentors during clinical training helped me make the decision to then go into nephrology. And I continue to surround myself with great mentors who helped guide me through some of my most challenging decision.
Saul Marquez:
Wow, that’s great. So you’re on your hike and everything kind of came together and you decided this is where I’m going to spend my my life’s work.
R. David Roer:
Exactly. It’s amazing what insight you can get from spending five months in the woods.
R. David Roer:
You know, it’s an incredible experience. I’ve had some, you know, time and nature, too, and there’s nothing like it. So what a great story. And what inspires your work in health care, Martha?
Martha Wofford:
Well, I’ve been in health care for almost 20 years, and I shifted from working on the payer sides, the provider’s side, because I really wanted to have a greater impact on patients and on the payer side. I used to talk about how convenience was the most important thing to consumers, which is true until you’re sick and then when you’re sick, what you want is really high-quality critical care. And I think an exceptional care experience. Now working at DaVita with kidney patients who are some of the most clinically complex in the health care system, if they so many of those social determinants of health barriers have that opportunity to help deliver high-quality care at the experience that’s been incredibly fulfilling and inspiring.
Saul Marquez:
And how about you, Doctor Roer, or what inspires your work?
R. David Roer:
Well, I was in practice for 30 years and always work to change the health care delivery system, to improve patient safety and quality while lowering costs and eliminating unneeded utilization. I saw how beating innovative teams in my office at the bedside with patients and our health systems and dialysis unit was effective in achieving these goals. Now, having the opportunity to lead clinical innovation at DaVita Integrated Kidney Care. I have an opportunity to have a greater impact. On improving the care of patients with chronic kidney disease, and end-stage kidney disease.
Saul Marquez:
Well, there’s certainly a lot of great experience that both of you comment to really the system to offer to provide the results that you guys have been. You guys are not new at value-based care. And we’re going to be diving into the work that DaVita has done. So how are you and the business? You know, and really the work that you guys do at DaVita adding value to the health care ecosystem?
R. David Roer:
Well, Saul let me start and then I’ll pass it over to Martha. First, let me give a quick overview of the prevalence of kidney disease and what big kidney disease population looks like. There are about one in three Americans at risk for chronic kidney disease. And that results in one in seven adults for about 37 million adults in the United States who are in one of the five stages of chronic kidney disease. And these patients are often unaware that they have kidney disease. Diabetes and hypertension are the leading causes of chronic kidney disease and kidney failure, which we now call end-stage kidney disease or ESKG. There are about six hundred and sixty thousand people who live with kidney failure and about a hundred thousand patients who are awaiting a kidney transplant. And remarkably, kidney disease is the ninth leading cause of death in the United States. Unfortunately, about 50 percent of patients crash into dialysis. What I mean by that is patients start dialysis urgently in the hospital, having had a concurrent illness. And they often had no idea that they had chronic kidney disease prior to that hospitalization. Once the patient’s kidneys have failed, they need life-saving treatment to replace their kidney function, to remove excess fluid toxins and waste products that build up in their bodies. Ultimately, the goal is moving upstream early in the course of the disease and initiate proven therapies to limit the progression of chronic kidney disease, to end-stage kidney disease and significantly limit the sequel of the disease. And I’ll turn it over to Martha.
Martha Wofford:
Yeah, and thank you, Dr. Roer, for all of that really important cycle context. I think it’s super important to our conversation. I wanted to highlight three areas where DaVita is really adding value. And the first is really straightforward. So DaVita works hard to deliver high-quality kidney care across the country every day. Second, I run a business within DaVita called Integrated Kidney Care, or IKC for short. And it DaVita IKC. We take full clinical and financial accountability for patients and by coordinating all their care. We improve their quality of life and reduce cost to the system. And just as a little aside, as a health policy gig, I would say that kidney patients are at the epicenter of that five percent of patients that drive 50 percent of cost to our health care system in America. And so it’s imperative that we take action and we have an incredible opportunity to address the root cause issues for these patients to truly address their health, helping prevent hospitalizations and reducing costs. Thirdly, we’re working hard, as Dr. Roer said, to help patients before their kidneys fail. A really sad part of the healthcare system today is that 50 percent of patients who crash into the house end up in the emergency room and crashing is costly and it’s really traumatic for the patient.
Martha Wofford:
And before a patient’s kidney fails, the patient had chronic kidney disease or CKD, and that often isn’t even diagnosed. So we’re working really hard to help patients identify that they even have CKD so that we can help them start managing their disease earlier. So we have two main ways that we support CKD patients. The first is conducting no cost community education across the country and online. And to date, we’ve educated more than one hundred and ninety thousand patients out there in these ways to manage their disease and empowered them to choose a treatment option. Then the second way is that we deliver disease management to help kidney doctors and their patients. Slow progression. And for those who do progress to help them choose the best treatment option for them, which could be transplant home dialysis and really be ready to start their treatment without any kind of a hospital.
R. David Roer:
Because, you know, we’re living in complex times and the need to deliver integrated care has been amplified during the COVID pandemic which has been challenging for all of us to navigate the healthcare system and even harder for patients with multiple comorbidities and chronic kidney disease and end stage kidney disease.
Saul Marquez:
Well, it’s certainly a very challenging population to care for. Dr. Roger, you mentioned some staggering statistics, and Martha, you covered a great top three of how you guys are helping tackle some of these issues, delivering high-quality care and focusing on those patients in those critical times, their progression and potentially even before they fail that 50 percent number. So just super important work on this five percent of patients. What would you say makes what you do different or better than what’s available today?
Martha Wofford:
Yeah, thanks for the question. Let me highlight a couple areas of differentiation and then I’ll hand it off to you, Dr. Roer. The first is integrating patient care. And so it is very, very fragmented today. And you can imagine for patients with multiple comorbid conditions, it’s that much worse. So we can help our patients with both their kidney and their non-kidney care needs. So, for example, we can help our patients get to the cardiologist or endocrinologist or psychiatrist in addition to treating their kidney failure. And we do this within the context of this volume to value shift into delivering really great integrated care. Where we get paid for delivering quality outcomes really aligns incentives. The second thing I would highlight is that we have a track record. We leave the industry an integrated kidney care outcomes. We’ve been at this for a very long time and we’ve built scaled capabilities and learned a lot of lessons along the way. In some of the key capabilities we’ve built are around predictive analytics. We have a very large volume of longitudinal patient data which powers those analytics. We have multidisciplinary care management teams with extensive kidney expertise. And I talked earlier by our patient education, but it is truly differentiated and award winning. The third thing I would highlight is that we address that full continuum of kidney care. Everything from CKD through EKG and transplant. And this integration really matters as we work to intervene upstream and to help avoid patients having their kidneys fail and having these high costs downstream episodes.
R. David Roer:
Well, thanks, Martha. To deliver on this continuum of care that Martha spoke of, DaVita has trusted relationships with nephrologist health systems, skilled nursing facilities in virtually every state in the United States that positions us to deliver integrated kidney care. We formed an organization called the Nephrology Care Alliance, which is a physician-led organization of about thirteen hundred nephrologists across the country, helping them be equipped to deliver effective, value-based care to patients with chronic kidney disease. Also, we know that home dialysis therapy, as I reviewed, is often the best choice for many patients with end-stage kidney disease. In fact, the data is the largest provider of home dialysis in the United States. Her investment over the years and home innovations such as home, remote monitoring and telehealth have helped patients choose and stay on home therapies. And we’re growing home therapies for times back in-center hemodialysis. Our dialysis center teams have integrated kidney care patients in over 90 percent of our clinics.
Saul Marquez:
It’s a big number. And, you know, in today’s day, with COVID and a lot of talks about the second wave coming. It’s critical that the business have the capability to take care of people at home. So that’s really promising. Dr. Ra and Martha, you talked about integrating care, the importance of doing that, the track record and the analytics and the full continuum of care. I mean, there’s no question in my mind. I mean, you guys are the ultimate partner in addressing this very complex disease, but also the people Right. the people that that are affected by it. And so what would you say? What you do has improved outcomes or maybe even made business models better. We’d love to hear from both of you on that one.
R. David Roer:
Sure Saul. Thanks. Our kidney team helped patients every day. So let me share a story about how power AKC teams have helped patients, especially through these complex kinds of the COVID pandemic. So during the pandemic, a patient needed to have a dialysis access procedure perform. This also required COVID testing in order to have a surgical procedure perform. Here is why we’re trying to get the testing done. But because of the difficulties in having the testing perform, this caused the patient to miss a dialysis treatment and have the vascular access appointment delay because. Patients in our Casey program, Integrated Kidney Disease Program, have access to additional resources such as a dedicated, integrated kidney care nurse. This patient’s nurse reached out to see how she could help. Not only did this nurse help by getting the Kovik testing performed, but also she was able to arrange the patient to receive a dialysis treatment in a special after hours shift so that the patient would not miss this lifesaving treatment while waiting for the test results. This is the power of coordinated care, preventing the patient from falling through the cracks by closing care and process gaps. When our patients mistreatment, the health consequences are dramatic and often results in a costly hospitalization and increased mortality. Our Casey model helps prevent poor health outcomes. Our integrated kidney team is a team of teams bringing together care teams to discuss patients and help solve their complex challenges in some of our national programs. We involve the payor and our care partners to bring their clinical and operational teams together with hours to discuss how partnering together we can close these care gaps and process gaps that lead to better health outcomes and improve the health care quality of life for our patients.
Martha Wofford:
Yeah, I think this does come down to people and their stories and these interventions really reduce hospitalizations with one regional peer partner. We have reduced hospital admissions approximately 30 percent each and every year of the past six years in lowering unnecessary hospitalizations produces costs. That’s better for the system. So much better for the patient. Nobody wants to be in the hospital and this helps patients have more days at home. And we work really hard to help patients treat on dialysis. With one national commercial payer partner, we’ve helped almost 35 percent of their patients treat on home, and that’s versus about the 13 percent national average. And again, this lets patients have more days at home, which is just so important to everyone.
Saul Marquez:
Some great examples from both of you. So thank you so much. I mean, a 30 percent reduction in hospital readmissions is huge. And just the collaboration with the payers you guys have going on is great. Is there any collaboration with large employers and large groups that are caring for the lives of many?
Martha Wofford:
We do care for patients that are part of large employer groups, but it’s through the insurance company. So we have partnerships with some of those very large insurance carriers that cover those big national account customers across the country.
Saul Marquez:
It. Very cool. Very cool. Well, I mean, the impact that you guys are having is super valuable. What’s one of the biggest setbacks you’ve had? I know, Martha, you mentioned at the beginning, right You’ve been a leader for a long time and there’s been a lot of lessons. So maybe you can share some of the biggest setbacks and key learnings that you and the team got from that.
Martha Wofford:
Yeah, and maybe I’ll start with, I think, something that’s more recent, which is there’s really been a significant focus on the kidney space in the past year. Partly that was the Trump administration’s policy moves and highlighting kidney. We’ve seen new companies enter the space. Some of this is exciting and encouraging. But the part that’s been discouraging is that we sometimes are on the receiving end of some of their criticisms. So even though we’ve been delivering these market-leading outcomes for kidney patients for years, we hear a lot about how we only care about managing CKD patients so that we can send them to our brick and mortar dialysis chairs when in fact we’re working so hard to slow patients, patients, kidney disease progression so they don’t need dialysis. Indonesia is the largest provider of home dialysis in the. Twenty seven thousand patients on home. And the rate of growth for our home program is four times that of our incentive program. That’s been a little discouraging. Over the past few months. And Dave, maybe you want to add a little bit about our journey.
R. David Roer:
Sure, Martha. You know, we’ve had some bumps and bruises along the way as we experience growth over the last 20 years in valu- based care. It’s been hard and we’ve learned a lot and how to evolve from intense resourcing to build our capabilities like our predictive analytics, which are so important to focus the right resources at the right time and enable us to become very effective and efficient in our care models.
Saul Marquez:
Well, those models certainly, you know, require efforts to make them work, you know, and there’s been some that do and some that don’t. Seems like you guys are definitely taking the steps and. Providing the right types of approaches, including integrated care to make value-based care work. What makes you most excited today?
R. David Roer:
Well, I believe we have a great opportunity. Our patients are some of the most at risk, clinically complicated patients, and they need a different tell me. They need their care can be coordinated. And I foresee great improvement for our patients through the integrated kidney care programs such as the integrated kidney care. Martha, what would you say?
Martha Wofford:
I am really excited about shifting to value based care. We are in an exciting, transformational time in kidney care where value based care really seems to be taking hold. I’m energized by helping patients identify CKD earlier and take the preventive actions changed. And lastly, for those patients who transition, empowering them to choose the right treatment option for their unique needs, which is often home for transplant.
Saul Marquez:
Love it. This is great and definitely a lot to be excited about. You know, it’s a confidence booster to know that, you know, DaVita, you, Martha and you, Dr. Roer, are just you guys are leading a great organization to help us get a better place with kidney care. And now we appreciate the work that you do for the listeners that are curious about best ways to get in touch. I love both of you could share the best way they could do that.
Martha Wofford:
Well, thank you for your kind words. They mean a lot. And to learn more about to be to integrate kidney care, please visit to be the case you got. Com or on Twitter. I’m at Martha Warford. Thank you.
Saul Marquez:
And Dr. Roer.
R. David Roer:
So you can get in touch with me also on Twitter at David Roer.
Saul Marquez:
Outstanding. So just want to give both of you a big thank you on behalf of all of us. It’s been an educational session. And again, just want to thank you so much for the work that you guys are doing there. Listeners,. you could reach out to either Martha or Dr. Roer or you can also go to outcomes, rocket that health and type in DaVita and the search bar. And you’ll see a full transcript of our discussion, including relevant links that’ll take you to any other resources and relevant information we discussed today. So, Martha and Dr. Raw. Thank you so much. Thank you. It was really a pleasure. Thanks all.
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