Bridging the Boardroom and Exam Room to Improve Kidney Care

Dr. Michael Casey led the formation of North Carolina Nephrology with a commitment to delivering exceptional patient care rooted in the principles of value-based care. His efforts have fostered collaboration among nephrologists, improved patient outcomes, and enabled data-driven care. Now, as part of Interwell Health's board of directors, he is excited to help empower the organization on its mission to reimagine kidney care.

Dr. Casey recently joined an employee town hall forum to talk about his career in nephrology and share his vision for the future of value-based kidney care. The following Q&A is an abridged account of that discussion.

Q: Dr. Casey, can you tell us a bit about your background and how you began your career in nephrology?

MC: I was born and raised in North Carolina. I completed both my undergraduate and medical school education at the University of North Carolina at Chapel Hill. After that, I went on to do my residency and fellowship at Wake Forest University in Winston-Salem, North Carolina.

I joined Wake Nephrology in 2001, and in 2017 we merged with Capital Nephrology to form North Carolina Nephrology. Today, our practice has grown to include 25 physicians and 23 advanced practice providers (APPs).

Q: Throughout your career in nephrology, what are some of the most notable changes you have seen?

MC: The evolution of the electronic health record (EHR) has been transformative for nephrology. When the 2019 HITECH Act first incentivized providers to move to EHRs, many practices adopted their own systems, creating silos with no cross-communication. With the expansion of Epic, including the use of Acumen Epic Connect in nephrology, we are seeing full use of a top-to-bottom system that provides the visibility to improve patient safety and create economic efficiencies.

Another significant change has been the increased use of APPs. We had no APPs in my original practice until about a decade ago. Now, my current practice is almost one-to-one with physicians and APPs. Our APPs have played a crucial role helping us achieve the aims of value-based care by expanding our bandwidth, increasing patient support, and enhancing patient education. There is no way we could be successful without them.

Finally, there are the clinical advancements with new drugs to treat diabetic nephropathy, which is the number one cause of end-stage kidney disease (ESKD) in the world. For 30 years, the latest clinical advancement in kidney care was the invention of ARBs. Now, GLP-1 receptor agonists and SGLT-2 inhibitors are changing the game by reducing the progression of kidney disease. In the last several years, as we’ve instituted these drugs more broadly, we’ve seen profound improvements in patients with kidney disease that we would not have expected to see just five years ago.

Q: How can we continue to encourage adoption of value-based care in nephrology?

MC: Around the time we completed the merger to form North Carolina Nephrology, we held several summit meetings bringing together nephrology groups, both at the physician and management level, to talk about best practices in kidney care. Along the way, we realized value-based care was one of those best practices.

In fee-for-service models, the motivation is not necessarily to create good outcomes. There is no incentive to go the extra mile; it is actually disincentivized. Many of the proactive interventions that patients need to stay healthy and out of the hospital take a lot of time and effort but are not reimbursed in a fee-for-service world, where churn and burn is what’s rewarded. In our conversations with other nephrology leaders, we all saw that value-based care empowered the type of nephrology care we wanted to provide by aligning financial reimbursement with our ethics and goals.

I believe in leading by example and I am passionate about living the value-based care approach in my personal practice to demonstrate that we can be successful in this model. And our partners see how value-based care is making their own patients healthier. That is a far greater motivator than me running the numbers each month and telling them if their revenue is down and that they need to see more patients and bill more. Value-based care is much more aligned with how we want to practice as physicians.  

Q: What excites you most about joining the Interwell Health board of directors?

MC: Representing the clinical side of nephrology on the Interwell board aligns perfectly with my career-long focus on patient-centered care. As physician board members, Dr. Charles Zachem and I take care of patients in dialysis units and our offices every day. Our role is to help bridge the gap between what happens in the boardroom and the exam room. We ensure that the suits continue to hear from the stethoscopes so we can maintain the practice-based focus that Interwell was initially founded on.