HHS Launches President Trump’s ‘Advancing American Kidney Health’ Initiative

Today, President Donald Trump signed an Executive Order to launch Advancing American Kidney Health , a bold new initiative to improve the lives of Americans suffering from kidney disease, expand options for American patients, and reduce healthcare costs. The initiative provides specific solutions to deliver on three goals: fewer patients developing kidney failure, fewer Americans receiving dialysis in dialysis centers, and more kidneys available for transplant.

As directed by the Executive Order, the U.S. Department of Health and Human Services (HHS) announced today that the Centers for Medicare & Medicaid Services (CMS), through its Center for Medicare and Medicaid Innovation (CMMI), released a proposed required payment model and four optional payment models to adjust payment incentives to encourage preventative kidney care, home dialysis, and kidney transplants. The Department’s Assistant Secretary for Planning and Evaluation (ASPE) also released a paper entitled Advancing American Kidney Health , which lays out a number of areas for action, including measures called for in the executive order, for various components of HHS to improve kidney care.

“President Trump is tackling the toughest issues in American healthcare, and few areas need reform more than the way we treat kidney disease,” said HHS Secretary Alex Azar. “Decades of paying for sickness and procedures in kidney care, rather than paying for health and outcomes, has produced less-than-satisfactory outcomes at tremendous cost. Through new payment models and many other actions under this initiative, the Trump Administration will transform this situation and deliver Americans better kidney health, more kidney treatment options, and more transplants.”

Across America, 37 million patients suffer from chronic kidney disease and more than 726,000 have end-stage renal disease (ESRD). There are nearly 100,000 Americans waiting on the list to receive a kidney transplant, and kidney disease ranks as the ninth leading cause of death in America.

Approximately twenty percent of dollars in traditional Medicare—$114 billion a year—are spent on Americans with kidney disease. Yet of the more than 100,000 American who begin dialysis to treat end-stage renal disease each year, one in five will die within a year. HHS has laid out three goals for improving kidney health:

Reducing the number of Americans developing end-stage renal disease by 25 percent by 2030
Having 80 percent of new ESRD patients in 2025 either receiving dialysis at home or receiving a transplant
Doubling the number of kidneys available for transplant by 2030

This week, HHS is taking a number of immediate actions toward these goals. To reduce the development of end-stage renal disease, CMMI released a set of four optional payment models, expected to enroll more than 200,000 Medicare patients in arrangements that give providers new incentives for preventing kidney disease and managing kidney patients’ health in a more comprehensive and person-centered way.

To provide more options for people with kidney failure, CMMI also announced a required payment model, known as ESRD Treatment Choices, which will enroll all dialysis providers in approximately half of the country and provide new incentives to encourage dialysis in the home.

To enhance patient access to transplantable organs, all five new payment models will give providers new incentives to help eligible patients receive transplants.

The President’s Executive Order also calls for HHS to:

Launch a public awareness campaign to increase knowledge of chronic kidney disease, which 40 percent of American patients do not know they have
Reform the organ procurement and management system in the United States to significantly increase the supply of transplantable kidneys
Expand support for living donors through compensation for costs such as lost wages and child care expenses
Encourage development of wearable or implantable artificial kidneys, through cooperation between developers and the Food and Drug Administration (FDA) and support for KidneyX, a public-private partnership between HHS and the American Society of Nephrology

As laid out in the ASPE paper, Advancing American Kidney Health, HHS will also, among other measures:

Improve Centers for Disease Control and Prevention (CDC) work on tracking and detecting chronic kidney disease throughout the population and supporting state and local efforts to develop a public health response for people with key risk factors
Expand work to study and implement evidence-based approaches to preventing kidney disease through CDC and the National Institutes of Health
Support work on portable dialysis options through the Assistant Secretary for Preparedness and Response to ensure individuals who need dialysis have ready access to treatment in the aftermath of disaster situations
Inform development of new kidney disease treatments that align with patient preferences, including alternatives to dialysis, through patient surveys being developed by the FDA
Examine ways to improve CMS’s ESRD payment policies
Continue research work through NIH to advance precision medicine for kidney disease
Launch additional prize competitions through KidneyX to support the development of new tools for preventing, managing, and treating kidney disease
Work further toward reducing disparities in performance among Organ Procurement Organizations (OPOs) and transplant centers with the goal of increasing recovery of kidneys by OPOs and utilization of kidneys by transplant centers.