Dr. Mahesh Krishnan Of Kidney Care Partners On 5 Things We Must Do To Improve the US Healthcare System
An Interview With Jake Frankel
We must figure out how to create settings that are most beneficial to the patient. Often, the site of care that is most convenient for the patient isn’t able to provide needed services. For example, within dialysis, there are services that could be done in the dialysis clinic but aren’t because it’s unclear what providers are reimbursed for.
As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview Mahesh Krishnan, MD, MPH, MBA.
Krishnan is the current Chair of Kidney Care Partners, a non-profit coalition of kidney care organizations and advocacy groups. Dr. Krishnan is a Group Vice President at DaVita Kidney Care. Previously, he has held various roles, including serving as the founding International Chief Medical Officer of DaVita, co-founding the DaVita Venture Group, and serving as the medical head of DaVita’s clinical research arm. Before joining DaVita, Dr. Krishnan served in various roles at Amgen, where he worked on medical affairs, health economics, and medical policy and played a key role in discussions with the Food and Drug Administration (FDA) and the Centers for Medicare & Medicaid Services (CMS).
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?
My personal connection to kidney care brought me to nephrology. My grandmother had chronic kidney disease (CKD), which progressed to end-stage renal disease (ESRD), or kidney failure, requiring her to receive dialysis treatments.
That experience drives my commitment to helping people identify kidney disease in its early stages to slow its progression. I’m also passionate about creating the best care system possible for ESRD patients, which includes access to transplantation and a choice in dialysis care.
Can you share the most interesting story that happened to you since you began your career?
When I served as the founding international Chief Medical Officer for DaVita, I set up the medical infrastructure for 250 clinics in 13 countries, including Portugal, Germany, Poland, Saudi Arabia, India, China, Malaysia, Singapore, Taiwan, Columbia, and Brazil. I’ve always thought that healthcare can be quite regional, but it was very interesting to see that up close and personal when moving into different countries. It required our team to be flexible and tailor care to the unique needs of each population. I learned so much about scaling healthcare services globally.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
Early in my career, I didn’t appreciate that people actually listened to me. I was once asked my opinion on a minor project. A few weeks later, there was an entire plan being presented, but some of the details seemed off to me. When I asked, “Why are we doing it this way?” I learned it was primarily shaped by my offhand comment. The lesson I learned was to be very careful and clear as to when I am giving a formal opinion or just discussing a topic in an offhand way.
As a leader, your words matter. While collaboration is essential, it’s important to distinguish between brainstorming and a clear directive.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My favorite quote is: “people don’t do what you expect of them; they do what you accept of them.” Since my mission statement is to improve the efficacy, efficiency, and safety of healthcare at scale and we are dealing with patient’s lives, I have to have high standards and hold people accountable for doing what’s best for the patient. Everything I do comes back to this. Whether that’s building new products or dealing with public policy, I try to shape my world to only accept things that are consistent with my standards.
How would you define an “excellent healthcare provider”?
I’d define an excellent healthcare provider as one producing high-quality, efficient healthcare that provides patients with a consistent experience. That’s harder to achieve when we’re talking about people and not widgets. Healthcare relies on people (both patients and healthcare providers), and understandably, people have different ways of doing things. There’s a unique challenge that comes with combining quality, efficiency, and consistency with that human element. And that’s why collaboration and communication in healthcare are so critical.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I’m old school in that I mostly rely on physical books. The book that was transformative for my career was one called Results by Gary Nielsen. He writes that, like individuals, each organization has a personality profile that informs how decisions should be made. This framework has been helpful in my career to ensure that information is flowing within an organization and enables individuals to make decisions aligned with our mission.
Are you working on any exciting new projects now? How do you think that will help people?
My big project right now is to fix the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) bundle. I was in the industry when the ESRD PPS was created legislatively and worked closely on its regulatory implementation.
When it was introduced, the bundle was transformative, but its limitations are becoming increasingly apparent. The ERSD PPS bundle is capped at 98% of 2008 expenses, which disincentivizes the development of new technologies and keeps patient care stuck in the past.
Through Kidney Care Partners, the nation’s kidney community is working to reform the bundle and bolster access to innovative technologies. We must ensure that patients with kidney disease have the same access to innovation as those with other chronic diseases.
According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high-income nations. This seems shocking. Can you share with us a few reasons why you think the US is ranked so poorly?
This is really a conversation about value. As a country, we spend a lot of money, but this article and others like it suggest that we don’t see a lot of value. One of the things that is increasingly clear to me is that we haven’t designed healthcare intentionally. We need to redesign the system to ensure that patients see what I’d call extreme value. To me, that means they can access healthcare when they need it and in the most efficient and transparent way. That should be done in a way that not only increases the value to the patient but also improves the cost to the system to deliver that care.
As a “healthcare insider” if you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system?
- We must sustainably pay for new innovations so that we encourage people to build better drugs, diagnostics, devices, or digital applications. In ESRD for example, a disease state that represents 2% of Medicare beneficiaries but consumes 6% of Medicare’s budget, there is no way to get sustained funding for any of these innovative items. Absent a change, there’s no real way to improve the quality of care or reduce expenses for those patients on dialysis.
- We must have a better mechanism for data to move between providers in a way that is easily usable. While we have successfully digitized a good amount of healthcare data, the data formats currently used along with their complexity have prevented the scaled effective use of that data. That’s in sharp contrast to the banking or cell phone industry, for example, which has achieved true interoperability globally that ultimately benefits consumers.
- We must use this data and information to get patients more actively involved in their care. Today, patients interact on a daily basis with a lot of their nonhealthcare data on their phones. As a result, they are able to make better decisions and be an active and not passive part of the process. We need to empower patients to do the same for their healthcare needs. Doing so will bridge the gap for care management activities that happen every day outside of formal interaction with healthcare providers. Diet is a great example, if patients interacted with their health data in a meaningful way, perhaps they’d be more able to comply with recommended diets.
- We must figure out how to create settings that are most beneficial to the patient. Often, the site of care that is most convenient for the patient isn’t able to provide needed services. For example, within dialysis, there are services that could be done in the dialysis clinic but aren’t because it’s unclear what providers are reimbursed for.
- We must fix the payment system for primary care. Primary care is so important, but it is reimbursed at quite a low rate, and as a result, medical students aren’t going into those fields. In our industry, there aren’t enough primary care doctors to identify chronic kidney disease (CKD) in its early stages.
What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
First, individuals need to become active participants in their own care and work closely with physicians to understand their risk factors and treatment options.
Since a significant portion of healthcare is provided as a benefit for individuals through their employer group, corporations have a big role to play in our healthcare system, too. As payers of healthcare, employer groups can be intentional about pushing for access to innovation, which can benefit their employees and save healthcare dollars overall.
Communities can play a vital role in fostering collaboration and data-sharing. With more knowledge, individuals can play a more active role in their care, as I mentioned above.
I have a particular passion for clinical leaders, especially those who are a triple threat — those who excel in medicine, can manage a population of patients, and can make a business case for their work. In my opinion, it’s much easier to teach clinicians business than to teach business leaders how to practice medicine.
The COVID-19 pandemic has put intense pressure on the American healthcare system, leaving some hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these issues moving forward?
If the COVID-19 pandemic made one thing clear, we must plan for uncertainty with certainty. Just a few months ago, we saw Hurricane Helene devastate the nation’s supply of IV and peritoneal dialysis fluid, which is used by patients undergoing home dialysis. Thankfully, the government and the companies rallied to address that issue by bringing in supplies from abroad. That’s just one example, but it tells us that it’s critical that we have viable contingency plans and bolster strategic reserves to be prepared for these crises and ensure that we can provide uninterrupted patient care, even in an unforeseen event.
How do you think we can address the problem of physician shortages?
We definitely see this in nephrology, as there is an insufficient number of people in the pipeline to handle the increasing number of individuals with kidney diseases. On top of that, physicians today are forced to spend more time on administrative tasks like filling out paperwork or completing prior authorizations.
There’s new technology that can help alleviate this burden and get physicians back to patient care. Examples include ambient electronic medical record [EMR] scribes that listen to a conversation and create needed documentation and the use of AI in physician correspondence. We certainly need to carefully think about the way technology is used in patient care, which will always require a human touch, but there are promising developments in this space.
How do you think we can address the issue of physician and nurse burnout?
This is a more complicated problem to solve. We need to intentionally design these professions to minimize things that could be automated or done by someone else. Unfortunately, many clinicians no longer have control over their workplace, the hiring of their clinical staff, or their patient volume. All of that is contributing to burnout.
Physicians have signed an oath to take care of patients no matter what and we’ll do what we must to maximize patient outcomes regardless of how bad the system is. Eventually, however, physicians and other healthcare professionals are going to burn out. As a country, we must address this, or we’ll continue to see this attrition.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
The movement I am most heavily invested in upscaling fellow clinicians to be the triple threat I mentioned earlier: those who don’t just excel in clinical practice but who can build mechanisms to scale their work and benefit patients.
I use the word clinician intentionally. It’s not just physicians but other healthcare professionals like nurses, dieticians, social workers, and others who can help improve the quality of healthcare at scale.
I ardently believe that those clinician leaders will have both the experience and empathy to design better future healthcare delivery systems. This will improve the efficacy, efficiency and safety of care delivery for patients and the healthcare professionals who have dedicated their lives to taking care of them.
How can our readers further follow your work online?
You can read more about my work in my recent interview with Signals or through my TEDTalk.
Check out Kidney Care Partners’ website for additional information on how we are ensuring that patients across the kidney care continuum can access the high-quality care they need and deserve.
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.
Dr Mahesh Krishnan Of Kidney Care Partners On 5 Things We Must Do To Improve the US Healthcare… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.