Kidney Week

Abstract: TH-PO0613

Value-Based Kidney Care in Practice: A Qualitative Study of Structure, Delivery, and Experience

Session Information

• CKD: Clinical - Guidelines, Biomarkers, Progression, Procedures, Outcomes, and More
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Ahmed, Umayr, University of Pennsylvania Department of Medicine, Philadelphia, Pennsylvania, United States

Umayr Ahmed, BS

• Klaiman, Tamar, University of Pennsylvania Department of Medicine, Philadelphia, Pennsylvania, United States

Tamar Klaiman, PhD, MPH

• Steckel White, Jenna, University of Pennsylvania Department of Medicine, Philadelphia, Pennsylvania, United States

Jenna Steckel White, MSW

• Shore, Doron M., University of Pennsylvania Department of Medicine, Philadelphia, Pennsylvania, United States

Doron M. Shore, MPH

• Agha, Aneeza, University of Pennsylvania Department of Medicine, Philadelphia, Pennsylvania, United States

Aneeza Agha, MA

• Reddy, Yuvaram N.V., University of Pennsylvania Department of Medicine, Philadelphia, Pennsylvania, United States

Yuvaram N.V. Reddy, MBBS, MPH, FASN

Background

Chronic kidney disease (CKD) affects 14% of U.S. adults, yet care delivery remains suboptimal, with many patients 'crashing' into emergency dialysis despite established pathways to slow progression. Value-based kidney care (VBKC) companies have emerged to identify high-risk patients and deploy multidisciplinary teams to bridge care gaps. However, the inner workings of VBKC and their real-world value to patients and providers remain largely unstudied. We conducted a qualitative study of one VBKC company to understand its structure, care delivery, and participant experiences.

Methods

We conducted semi-structured qualitative interviews with 14 employees and 15 patients and caregivers associated with a VBKC company. Employees, primarily physicians, nurses, pharmacists, and non-clinical staff were recruited through purposive and snowball sampling; patients with advanced CKD and some caregivers were randomly selected for interviews. Interviews were conducted virtually between May and September 2025 and professionally transcribed. Transcripts were analyzed in NVivo using a hybrid inductive-deductive codebook. Coding discrepancies were discussed during weekly meetings and refined through team consensus.

Results

Three themes emerged from 29 interviews: 1) The model for VBKC rapidly evolved from care coordination to active co-management through regional clinical care teams, eventually expanding into a 'polychronic' care model addressing comorbidities beyond CKD; 2) VBKC teams used home and remote visits to bridge care gaps and coordinate care; and 3) VBKC employees felt personal and clinical satisfaction in providing VBKC over traditional fee-for-service care, citing meaningful patient relationships and better work-life balance, though some staff faced challenges adapting to home-based care.

Conclusion

This qualitative study of clinicians and patients engaged with a VBKC company reveals how value-based care in nephrology is organized and delivered. It highlights VBKC as a tool to improve care delivery for patients and providers. As the US continues to shift towards value-based care, more work is needed to help patients and providers decide whether and how to engage in VBKC.

Figure 1. Monogram Health's role in bridging care gaps

Funding

• Private Foundation Support