Nephrologists Are Securing More Upstream Patient Referrals from Primary Care

Author : Strive Health

It may seem obvious that nephrology care is critical for better health outcomes among kidney disease patients, but historically most late-stage kidney disease patients have not been referred to nephrologists. Lack of connectivity between primary care physicians (PCPs) and nephrologists, among other factors, has kept the majority of late-stage CKD patients from ever seeing a nephrologist before their kidneys fail. Strive’s analysis of claims data shows that 54% of CKD Stage 4 and 5 patients have not seen a nephrologist within the past 12 months.

Nephrologists need early access to patients in order to adequately treat kidney disease and prevent progression to kidney failure. New trends in primary care, driven primarily by value-based payment models, have empowered nephrologists to secure more upstream CKD patient referrals, make a more significant impact on patient outcomes through earlier intervention, and substantially grow their practice.


Over 50% of PCPs now participate in Medicare or commercial ACOs and have accountability for the total cost of care of their patients through these models With much of the total cost of care driven by specific disease states and comorbidities, PCPs are now aligning with specialists who can help them reduce total cost of care and achieve quality bonus measures.

Kidney disease patients have a disproportionately high cost compared to the average primary care patient, which makes it critical for PCPs to find high-quality and low-cost specialty care for these patients. Increasing planned dialysis starts is one key opportunity to improve care quality and reduce healthcare costs. When patients start dialysis with a permanent vascular access in place or in an outpatient setting, patient outcomes are significantly better, and costs are substantially lower. Strive analysis suggests that the cost of inpatient dialysis starts is 8x-10x higher than starts in outpatient settings, yet 46% of new dialysis starts take place in the hospital (see Figure 1).

Figure 1. Cost difference between inpatient and outpatient dialysis starts

Patients are more likely to experience smooth, planned dialysis starts when they receive upstream nephrologist care. Nephrologists coordinate vascular access, provide dialysis modality education, and ease patients onto the therapy. Nephrology care is also critical for providing kidney-specific disease management, including medication reviews and nutrition modifications, which further improve outcomes and reduce healthcare costs.

In the future, PCPs and nephrologists will better align on when kidney disease patients should be referred to nephrology care, what labs trigger that referral, and how the patient will be co-managed. Value-based models align PCPs and nephrologists around shared goals, which creates an opportunity for better integration. As more PCPs become educated on the importance of upstream kidney disease management, they are increasingly referring to nephrologists who help them meet their own value-based payment objectives.


As more PCPs look for high-quality and low-cost nephrology care for their kidney disease patients, nephrologists are now empowered to win these referrals by leveraging their own quality and cost performance data. Nephrologists who are armed with real data and can demonstrate their ability to improve quality and reduce total cost of care compared to the market average are well positioned to approach PCPs and make a strong case for why referrals should go their way. The earlier these referrals take place, the greater the opportunity for nephrologists to manage outcomes and cost, which makes the case for upstream CKD referrals even more compelling

Even if nephrologists do not proactively approach PCPs with value-based care results data, ACOs and physician groups are starting to narrow their specialist referral networks and make referral decisions based on quality and cost performance by running their own data analysis, ranking specialists by their outcomes. This makes it even more important for nephrologists to stay ahead of the curve by proactively presenting their case to receive new CKD patient referrals based on value.

Nephrologists were previously left on their own to collect quality and cost data, develop a case for receiving value-based referrals, and approach PCPs to present it. But now nephrologists can partner with innovative companies that specialize in value-based kidney care who collect and analyze data received through value-based payment models, educate PCPs on the case for value-based nephrology care, and help facilitate access to new upstream CKD patient referrals. Leading value-based kidney care companies apply advanced data models to identify which members of a PCP’s patient panel should be referred to nephrology care.

“This type of practice transformation [Aligning nephrologist and PCP goals] will inevitably lead to stronger referral patterns and sustainable practice growth.”

– Stephen Clyne, D.O., Sr. Nephrologist, Michigan Kidney Consultants

These trends have empowered nephrologists who demonstrate high-quality and low-cost outcomes to improve patient care and grow their practice in ways they could not in the past.


The new payment models introduced by the CMS are indicative of an industry shift toward value-based care. Strive Health partners with nephrologists, health systems, payors, and medical groups to create integrated solutions that make effective value-based kidney care a reality.

Our partnerships include solutions to support you and your patients transition to value-based kidney care.  To talk more about value-based care options, complete our contact form and we will reach out.

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