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Remarks at the American Society of Nephrology Kidney Week Event

Alex M. Azar II
American Society of Nephrology Kidney Week
November 7, 2019
Washington, D.C.

You want to build for kidney patients what President Trump envisions for all Americans: a system that’s personalized, patient-centric, puts you in control, and treats you like a person, not a number. With your help, that’s the kind of system we’re going to build for kidney disease, and it’s going to deliver what we all want for America’s kidney patients: better health and longer lives.

As Prepared for Delivery

Thank you, Mark, for that introduction, and thank you so much to the American Society of Nephrology for having me here.

The awards you've conferred on HHS leaders today are a tremendous honor. On behalf of all of our awardees, I want to say thank you for this recognition.

While you've recognized particular leaders from HHS today, these awards are also a tribute to the hard work that so many men and women across HHS have been doing to advance American kidney health.

The vision we've laid out, and the progress we're going to make with all of you, would not be possible without the dedication of so many public health professionals, scientists, and researchers across HHS.

We also would not be where we are today, on the cusp of a major revolution in how America cares for kidney disease, without all of you here for the ASN meeting.

Whether you're a health professional who works with kidney patients, a researcher, a patient with kidney disease yourself, or involved in supporting kidney patients some other way, I'm grateful for what you do.

So I want to begin by giving you all a round of applause: You, and your dedication to American kidney health, are one of the main reasons I have hope that we can deliver on our shared vision.

The first place where we began laying out this administration's vision for kidney care was the National Kidney Foundation's patient gathering earlier this year.

We were told that just identifying all of the problems in American kidney care, and all the opportunities we have to improve it, was more attention than federal leaders had paid to this issue in a long time.

Well, we followed up that diagnosis with a plan for action: President Trump's executive order on advancing American kidney health, and the initiative it launched at HHS.

Today, I'm pleased to say, we are well on our way in executing on that plan, and I want to give you a brief update on it.

The plan has three parts: first, more efforts to prevent, detect, and slow the progression of kidney disease; second, more options for treating kidney failure, from both today's technologies and those of the future; and third, more organs for transplants.

We've set out highly ambitious goals for each of these areas: First, reducing the number of Americans developing end-stage renal disease by 25 percent by 2030; second, reducing the number of Americans receiving dialysis in a dialysis center, from 2019 levels, by 80 percent by 2025; and third, doubling the number of kidneys available for transplant by 2030.

In setting these goals, we have been so encouraged by the enthusiasm and engagement of America's nephrologists. You want to aim high, and that's exactly what we're doing.

With goals like these, there's no time to waste—so we've already gotten started.

First, on Monday, I was honored to launch a partnership with ASN and the National Kidney Foundation to educate Americans on how they can improve their kidney health. Working together with the NKF and all of you, we can promote early identification, treatment, and management of kidney disease.

These public health efforts have to be supplemented by changing the incentives around kidney care.

That's why we've launched four optional payment models, known as Kidney Care Choices, expected to enroll more than 200,000 Medicare patients in arrangements with new incentives to prevent the progression of kidney disease and manage kidney patients' health.

We recently posted the Requests for Applications for these models, and I made that announcement to a room full of physicians and entrepreneurs who are interested in value-based care.

I joked that this announcement wasn't a reason to stop listening and start pulling out their phones to read through the new applications. It was supposed to be a joke, until it became obvious that, yes, half the room literally was pulling out their phones to start checking out the applications.

That's the kind of enthusiasm we're seeing from America's nephrologists and other providers who are excited about getting paid for outcomes.

Better payment incentives are a powerful and necessary piece of transforming the care kidney patients receive. We're currently reviewing comments received on a proposed mandatory model, known as ESRD Treatment Choices, that will give a significant portion of dialysis providers new incentives to encourage dialysis in the home.

We've got a long way to go: Just 12 percent of American kidney patients start treatment at home with hemodialysis or peritoneal dialysis. This is the complete opposite of the situation in some of our peer nations, including Hong Kong, where more than 80 percent of patients benefit from some form of in-home dialysis. Heck, Guatemala is at 56 percent peritoneal!

Under our proposed mandatory model, a significant portion of Medicare ESRD patients will be able to benefit from the expanded options encouraged by this model, with the support and education they need to benefit from them.

Within all of these models, we're not just going to pay for better, more person-centered prevention and dialysis—we're also going to provide new incentives to encourage transplants.

Today, we have a system that pays for dialysis, rather than transplants—so what we get is lots of dialysis, and not as many transplants as we should have. It's time for that to change.

Transforming lives through more kidney transplants will also require expanding the supply of transplantable organs, and we're hard at work on that, too.

I had the opportunity to meet with a number of transplant and organ procurement leaders last week, and I left that meeting highly energized. Getting the maximum number of transplantable organs to patients who need them is an incredibly complex challenge, but we're going to get better at it, and we're going to do it soon.

That includes a number of steps laid out in the President's executive order, such as reforming the metrics by which we judge organ procurement organizations, and expanding the support we provide for living donors.

We want to do everything we can to improve America's transplant system, from supporting those who chose to be donors, to managing the procurement of organs, to improving the care received by transplant patients.

Today, I'm pleased to announce one new step toward an optimal transplant system. In mid-November, the Health Resources and Services Administration will issue a Request for Information about more effective ways in which modern IT systems may be able to manage allocating organs and handling patient and donor data on a national scale. We especially want to hear from entities that are capable of developing a system that is more effective than the one we have today, and we want to hear from all fields and industries, both non-profit and for-profit. 

We've also brought that kind of collaborative spirit, looking across all industries, to KidneyX, our partnership with ASN to accelerate development of breakthrough technologies.

Through KidneyX, we've made awards to 15 teams across the country to redesign dialysis. We've heard from hundreds more teams who are entering the kidney space, recognizing the opportunity to help so many people in need of innovation.

Submissions for the second phase of Redesign Dialysis, to bring products to prototype, will open November 18th.

Today, I'm also pleased to announce we are issuing an RFI about how KidneyX can help bring these advances into human trials. As part of the RFI, we've included a new summary of regulatory, coverage, and payment options for a wearable or implantable artificial kidney, including the availability of Fast Track programs at FDA.

Today, I can also announce that NIH has opened up applications to its small-business innovation research program for the development of new technologies that can further advance us toward this critical goal of an artificial kidney.

We are focused, in all of this work, on empowering patients to have the choices and flexibility they need. Improving American kidney health means working hand-in-hand with patients.

Toward that end, last week, the FDA awarded a contract to the Kidney Health Initiative for a three-year project that will measure patient preferences and risk tolerance for novel treatments for kidney failure, allowing the FDA to better incorporate patient input into the development and review of new technologies.

That's a lot of news in just a couple weeks—I want to give everyone at HHS and throughout the kidney community a round of applause for their work on these initiatives.

Many of you know how I personally came to be familiar with kidney disease: My father suffered from end-stage renal disease, and spent several years on dialysis. I saw how draining the experience is.

I also know how much better it got when he learned he could do peritoneal dialysis, and then I saw his life transformed by the generosity of a living kidney donor.

This was a challenging, stressful experience for our family—despite the fact that my dad was not only a physician himself, but had a son who was the former Deputy Secretary of Health and Human Services!

I cannot begin to imagine how helpless and confused so many Americans feel about the trials of kidney disease and dialysis.

I know that all of you want nothing more than to change that. You want to build for kidney patients what President Trump envisions for all Americans: a system that's personalized, patient-centric, puts you in control, and treats you like a person, not a number.

With your help, that's the kind of system we're going to build for kidney disease, and it's going to deliver what we all want for America's kidney patients: better health and longer lives.

I look forward to working with all of your toward those goals. On behalf of our entire team, thank you so much again for this honor, and thank you for having me here today.

Content created by Speechwriting and Editorial Division 
Content last reviewed on November 7, 2019