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Remarks on ‘Advancing American Kidney Health’ Initiative

Alex M. Azar II
Press conference
July 10, 2019
Washington, D.C.

This effort is the most significant initiative undertaken on kidney disease by any President, and the single biggest change to how we treat this disease since Medicare began covering end-stage renal disease patients in 1973.

As Prepared for Delivery

Good afternoon, everyone, and thank you for joining us here today.

As you just heard, today is an incredibly exciting day for kidney patients in America.

The President is launching an initiative to dramatically improve care for the approximately 37 million Americans with kidney disease, and, most importantly, to improve their health.

This effort is the most significant initiative undertaken on kidney disease by any President, and the single biggest change to how we treat this disease since Medicare began covering end-stage renal disease patients in 1973.

It is immensely gratifying to help lead this effort because, as I mentioned, I know the burdens of kidney disease personally.

My father suffered from end-stage renal disease and, like others, he initially had to go to dialysis multiple times a week. I saw how draining it is.

Thankfully, as has been true for many of the patients here today, my father’s situation improved.

First, we found out that he could receive peritoneal dialysis, allowing him to be dialyzed at night in the comfort of his home. Then, we were blessed that he was offered a kidney transplant from a kind and generous living donor.

My father’s story has a happy ending, and we know he was lucky. Too many Americans don’t know about or aren’t supported in shifting to more convenient dialysis options, and too many Americans never get a chance at a kidney transplant.

That has to change, and that’s why we’re launching the President’s initiative, Advancing Kidney Health in America, with the signing of his executive order today.

Under the umbrella of this initiative, we’re going to use every tool we have, across HHS, to deliver better health for kidney patients.

We’ve set out specific, ambitious goals: reducing the number of Americans developing end-stage renal disease by 25 percent by 2030, reducing the number of Americans receiving dialysis in a dialysis center, from 2019 levels, by 80 percent by 2025, and doubling the number of kidneys available for transplant by 2030.

I want to explain some specific steps we are taking in response to this executive order and to accomplish these goals.

First, to reduce risk of kidney failure, we are launching four optional payment models. These models are expected to enroll more than 200,000 Medicare patients in arrangements that offer new incentives to prevent the progression of kidney disease and manage kidney patients’ health in a more comprehensive and person-centered way.

Within that set of models, there is one pathway for nephrologists to receive bonuses for keeping patients healthy, and three models for local entities to take on different levels of financial risk for the health of their patients.

Second, to provide more options for people with kidney failure, we are launching a mandatory payment model, known as ESRD Treatment Choices, which will give about half of all dialysis providers new incentives to encourage dialysis in the home. This means about 50 percent of Medicare patients with kidney failure will be able to benefit from the expanded options encouraged by this model, with the support and education they need to benefit from them.

Through public-private partnerships, we will also support the development of artificial wearable and implantable kidneys, and we will continue advancing the use of portable dialysis technologies to care for patients during natural disasters.

Third, to enhance patient access to transplantable organs, all of these payment models will give providers new incentives to help patients receive transplants—something our current payment system doesn’t adequately support. Further, the President’s executive order calls for us to reform our organ procurement and management system so that we can significantly increase the supply of transplantable kidneys. We also need to support generous living donors.

Today, we’re joined by Conley Marie Rohall, a 14-year-old who was born premature and with damaged kidneys. She recently received a kidney donation from her mother, Anne, who works at HHS and is also here today. They’re both doing well, and Conley Marie was just cleared to return to school and start swimming. We need to better support generous living donors like Anne, and we’re going to continue exploring how to do that.

All of the solutions we’re working on are laid out in a new planning paper we released today, Advancing American Kidney Health, which I encourage all of you to look at.

I want to conclude by explaining how this kidney initiative fits into the President’s broader work to put the patient at the center of our healthcare system—with the affordability you need, the options and control you want, and the quality you deserve.

There may be no better example than kidney care of how government domination of healthcare can sideline patients, discourage innovation from providers, distort payment incentives, and focus only on paying for treating sickness, rather than preventing disease and supporting health.  

For decades, across all of American healthcare, and kidney care in particular, the focus has been on paying for procedures, rather than paying for good outcomes.

We need to flip that around: We’re going to start paying providers for better health outcomes, rather than procedures, and we’re going to pay for health, rather than simply paying once people are already sick.

That is the vision we have for all of Medicare, and so I’m now going to turn it over to Administrator Verma, who will explain more details of our vision for patient-centered kidney care, and then we’ll hear from Adam Boehler, for more details on the payment models he is launching at CMS’s Innovation Center.

Content created by Speechwriting and Editorial Division 
Content last reviewed on July 10, 2019