Why High-Value Networks Matter More Than Ever in Kidney Care

As payors narrow provider networks around measurable performance, one question has become increasingly important: What actually makes a kidney care network “high value”? For payors, providers and patients, the answer isn’t always the same.
As healthcare shifts further toward value-based care, the conversation is moving beyond simply building larger provider networks to identifying the clinicians and care teams that consistently deliver quality care that results in better outcomes. 

For kidney disease, that distinction matters. Patients often require years of coordinated care across nephrology, primary care, cardiology and other specialties. The practices best equipped to deliver that care aren’t necessarily those with the greatest volume of patients, they’re the ones with the infrastructure, data and clinical processes to intervene early, coordinate effectively and prevent avoidable complications. 

In this edition of Strive Innovation Lab, a series that explores how leaders and clinicians are reshaping value-based kidney care, Chief Nephrologist Keith Bellovich, D.O., MBA, explains what defines a high-value kidney network, why nephrology is uniquely positioned to lead value-based care and what payors should look for as they evaluate network performance.   

Q: Value is a word often associated with healthcare. What does value mean in kidney care?
A: I always start with the value equation: quality divided by cost. That’s really what sits underneath every conversation about value-based care. 

Everyone wants the highest possible quality, but healthcare doesn’t operate with unlimited resources. The challenge is finding the point where you’re delivering excellent outcomes without creating unnecessary cost. 

People sometimes assume improving quality always means spending more money. That’s not necessarily true. In many cases, better quality actually reduces costs because you’re preventing avoidable complications, hospitalizations and unnecessary utilization. 

Kidney care is a perfect example. Preventing someone from progressing to dialysis or preparing them for an optimal dialysis start if progression is unavoidable improves quality while avoiding some of the most expensive events in healthcare. That’s where value-based care becomes real. Not by spending less, but by preventing the complications that cost patients and the healthcare system the most. 

Q: What separates a high-value kidney network from a traditional referral network?
A: A referral network simply connects patients to specialists. A high-value network is accountable for outcomes.  

The practices in high-value networks aren’t just seeing patients; they’re measuring performance, identifying gaps in care and continuously improving how they deliver care. They invest in population health infrastructure, care coordination, quality measurement and multidisciplinary collaboration. 

They also understand that transformation requires work. You’re asking physicians and practices to fundamentally change how they deliver care. That requires leadership, data and support. 

That’s where organizations like Strive Health come in. We don’t replace local nephrologists; we strengthen them. Every practice is different. Some already have strong capabilities. Others need additional resources, care management or technology. Our role is to help elevate every practice by working alongside local nephrologists to care for the patients we serve together so patients receive consistently higher-value care and a seamless, connected experience regardless of where or when they enter the system. 

Q: One thing we’ve been hearing from payors is that they’re increasingly narrowing networks around high-performing nephrology groups. Why is that happening now?
A: The healthcare system cannot continue paying for preventable complications or low-quality care that provides no benefit to patients, such as redundant testing, failure to address social drivers of health or high-cost therapies with unproven efficacy. Payors also face the administrative burden and cost of fragmented care across multiple specialists. They need one trusted partner to support members throughout their healthcare journey with seamless transitions, connected care and proactive interventions. 

Kidney disease represents a disproportionate share of healthcare spending, particularly as patients progress toward kidney failure. Payors are looking for partners that can improve quality, slow disease progression, reduce unnecessary utilization and lower total cost of care, while improving the patient experience and outcomes. 

Nephrology is well-positioned for this transition because we’ve been participating in value-based models for many years. We’ve learned that success isn’t just about treating advanced disease; it’s about identifying patients earlier, slowing progression whenever possible and preparing patients appropriately if progression occurs. 

That’s why high-performing nephrology practices have become increasingly valuable. They’re not simply delivering specialty care. They’re trusted partners coordinating care across the patient journey and reducing avoidable complexity and cost for the healthcare system. 

Q: Who gets to define what makes a “high-value network?” Does the answer change depending on who’s asking?
A: Absolutely. A health system, nephrologist and payor may all begin with different priorities, but ultimately, they’re trying to solve the same problem. 

Quality has historically been a somewhat subjective term.  What one stakeholder considers high-quality care may not be the same as another’s. Both the challenge and the opportunity is transforming those subjective opinions into objective, measurable and timely performance that enhances an individual’s life. 

That’s exactly where value-based care changes the conversation. Instead of asking whether a network feels high- value, we can evaluate whether it’s consistently delivering measurable improvements in patient outcomes, slowing disease progression, reducing avoidable hospitalizations and using healthcare resources most efficiently. 

When you establish those objective measures, perspectives will begin to align. A payor may focus on total cost of care, while a nephrologist focuses on delaying kidney failure, but both benefit when patients stay healthier, avoid unnecessary utilization and receive the right care at the right time. That’s what a truly high-value network should deliver. 

Q: If you were advising a payor evaluating kidney care partners, what would you tell them to look for?
A: I would start by looking beyond utilization alone.  

It’s more than whether an organization has good outcomes; it’s whether it has the infrastructure and culture to continuously improve them. For example, does the organization have a clear commitment to quality improvement? Have they invested in population health capabilities? Are clinical leaders routinely reviewing performance data, identifying opportunities for improvement and acting on those insights? 

From there, I’d look at the clinical measures. Are patients being identified early? Are evidence-based therapies being used consistently? Are patients starting dialysis with appropriate preparation rather than through emergency admissions? Are avoidable hospitalizations and complications declining over time? 

That commitment to accountability and continuous improvement is often what distinguishes a true high-value network from a traditional referral network.

Q: Looking ahead, where do you think value-based kidney care is headed?
A: We’re moving beyond thinking about kidney disease in isolation. Patients don’t experience kidney disease distinctly from other chronic conditions such as diabetes mellitus, cardiovascular disease or hypertension. Increasingly, we’re thinking about cardiorenal-metabolic health as an interconnected continuum.

That approach requires closer collaboration among specialists, primary care physicians and health plans.

It also requires recognizing that intervention isn’t something you do once disease becomes advanced. The greatest opportunity often comes much earlier, identifying patients sooner, coordinating care earlier and preventing avoidable complications before they happen.

Ultimately, high-value networks aren’t defined by the number of providers they include. They’re defined by their ability to consistently improve patient outcomes. That’s the direction healthcare is moving, and kidney care is well positioned to lead the way.

Interested in learning more? 
If you are a payor or employer looking to improve outcomes, reduce costs and create a better experience for people living with kidney disease,  connect with Dr. Bellovich and the Strive Health team to learn more. To read last quarter’s Strive Innovation Lab blog about elevating the patient experience, click here.