How Strive Health’s Value-based Care Model Improves Hypertension – and Reduces the Risk of Kidney DiseaseAuthor : Dr. Keith Hopkins, Physician
Nearly half of adults in the U.S. have high blood pressure, otherwise known as hypertension. Although early stages of hypertension often present no symptoms, high blood pressure can cause serious health conditions when left untreated. In fact, hypertension is the second leading cause of kidney failure — and puts people at greater risk for heart disease and stroke, the leading causes of death in America.
Although we can effectively manage high blood pressure through prescription medication, ongoing monitoring and lifestyle changes, the vast majority of people do not have their condition under control. Why is high blood pressure so difficult to manage?
The root problem comes down to weak relationships between providers and patients — and the lack of attention given to managing chronic health conditions and proactive wellness under traditional fee-for-service (FFS) healthcare models.
But there’s a better approach to managing high blood pressure. Strive Health’s model focuses on value-based care (VBC), which reimburses providers based on the quality of outcomes achieved, rather than the volume of services rendered. By incentivizing providers to focus on preventative measures, our model facilitates a more effective approach to managing and mitigating chronic conditions like hypertension that impact kidney health.
A vicious cycle: How kidney disease and hypertension play into one another
Hypertension occurs when the force of blood against the walls of the arteries is consistently too high, either because there’s too much fluid volume or too small of vessel size.
When your blood vessels are too small and your vital organs don’t receive the amount of blood they need to properly work, the kidneys respond by releasing hormones that increase blood flow and, in turn, result in high blood pressure. Consistently high blood pressure wreaks havoc on the kidney’s ability to regulate blood pressure, which leads to further high blood pressure and worsened kidney function. It’s a vicious cycle that, when left uncontrolled, hastens the progression of kidney failure. It’s an unfortunate reality that approximately 1 in 5 adults in the U.S. with hypertension also suffer from chronic kidney disease (CKD).
The mechanisms to lower blood pressures are well-understood, typically involving a combination of prescription medication, management of comorbidities like diabetes, ongoing monitoring via blood pressure measurement, and lifestyle changes, such as regular exercise, eating healthy, reducing alcohol consumption and not smoking. Of the 116 million U.S. adults with hypertension, 91.7 million, or nearly 80%, are recommended prescription medication alongside lifestyle modifications.
However, despite ample knowledge around effective healthcare precautions and interventions, managing CKD, hypertension and other comorbidities is still challenging within our current healthcare system. Under a FFS model, healthcare providers are incentivized to focus on treating symptoms after they’ve developed rather than providing ongoing preventive care. As a result, providers have little time to connect with patients, talk about their condition, and build the trust and rapport required to help people understand how to manage high blood pressure and avoid serious outcomes.
The FFS model simply isn’t the most effective system for managing high blood pressure long-term and preventing conditions from becoming chronic diseases.
A more viable option: Strive Health’s kidney-focused VBC model supports the whole patient
Strive Health’s model helps solve deep-seated healthcare issues. In fact, a recent study of Strive Health’s value-based kidney care model found a 48% increase in the percentage of CKD patients who had hypertension and significantly improved blood pressure readings.¹
Let’s take a closer look at three components of the Strive Health care approach that led to healthcare advancements like this, and how our care model improves outcomes related to high blood pressure and kidney disease.
1. Team approach: Numerous studies have shown that consistent follow-up appointments, dietitian team interventions and treating patients where they live, attend church or get their hair cut have a lasting impact on controlling blood pressure, beyond the use of prescription medications. Our care model is anchored by our Kidney Heroes™, a multi-disciplinary team of nurses, care coordinators, dieticians, pharmacists, social workers, and other providers who work together to develop personalized care plans that empower patients to play an active role in their own care through ongoing education, resources, and support.
Our Kidney Heroes™ team supplements a traditional nephrologist’s work — increasing accessibility, offering support, and providing care in between physician appointments, whether that’s at a physician’s office, in the hospital or at a patient’s home. Kidney Heroes™ are also there to:
- Remind patients to refill prescriptions and schedule follow-up appointments.
- Offer encouragement and accountability for healthy eating and regular exercises.
- Provide ongoing support and answer questions in between nephrologist appointments, and more.
By leveraging the expertise of multiple healthcare professionals at once, we can inspire stronger relationships with our patients and provide a comprehensive approach to managing kidney disease and subsequently our patients’ blood pressure and other chronic conditions.
2. Holistic approach: Decades of research demonstrate a clear link between social determinants of health (SDOH) and kidney disease. For example, individuals living below the federal poverty level have a significantly greater probability of having chronic kidney disease and a 50% higher risk of progressing to end-stage kidney disease (ESKD). Clinical care is only one piece of the puzzle when managing and preventing high blood pressure and kidney disease. In fact, SDOH account for 50% of health outcomes, while clinical care accounts for only 20%.
At Strive Health, we care for each patient holistically. We consider a patient’s personal habits like physical activity and diet, as well as their socioeconomic status, education, social support networks and more. By understanding and addressing these factors together, we create customized care plans tailored to the unique needs and challenges of each patient.
For example, given that transportation is often a significant barrier to ensuring ongoing treatment, we will meet patients in their homes or elsewhere, or arrange alternative transportation methods so they can attend appointments and receive required care. By simultaneously addressing the social, economic and environmental factors that impact each patient’s health, we can help patients achieve better health outcomes and a higher quality of life.
3. VBC approach: Managing kidney disease involves high-touch interventions, such as discussing a patient’s habits, identifying key contributing factors and working with them to implement sustainable life changes. That’s especially important given how drastically high blood pressure can exacerbate the effects of an unhealthy lifestyle. Because our model is rooted in VBC, our providers have dedicated time and resources to invest in strong, lasting relationships with our patients to effectively monitor and manage their conditions over time.
The model also enables our clinicians to offer a wider range of treatment options for related comorbidities, catching them earlier and reducing the risk of other chronic diseases from developing.
In particular, Strive Care365 is designed to offer convenient and accessible care services via a range of appointment options from telehealth visits to home visits that 90% of our patients elect to receive, in addition to 24/7 access to nurses.
This inclusive approach improves patient outcomes and reduces provider costs. By focusing on prevention and early intervention, we help patients avoid hospitalizations and other costly medical treatments. One study about direct contracting, which is a type of value-based care model, found that the model generated $70 million in net savings for Medicare.
Managing kidney disease is a high-yield intervention that reduces the risk of cardiovascular, brain, and kidney diseases, and other serious health problems like hypertension. Hypertension is often “a silent killer,” but it wouldn’t be if we did a better job of listening to our patients, working alongside them to course correct treatment plans, and intervening before early symptoms lead to bigger problems.
With a more preventative and personalized healthcare approach, we can break the dangerous link between high blood pressure and kidney disease once and for all.
1. Calculated by comparing the percentage of Strive Health CKD patients who had hypertension (HTN) and subsequently controlled their blood pressure in multiple markets between January 2021 to March 2021 and January 2022 to September 2022.