Pharmacy Practice Standards for Outpatient Nephrology SettingsPatients with kidney disease represent a medically complex group of patients with high medication burdens that could benefit from clinical pharmacy services as part of the interdisciplinary care team to optimize medication use. The “Advancing American Kidney Health” executive order includes new value-based reimbursement models to be tested by the Center for Medicare and Medicaid Innovation beginning January 2021 and January 2022. Advancing American Kidney Health executive order poses opportunities for the inclusion of comprehensive medication management. Following an iterative process integrating input from a diverse expert panel, published standards, clinical practice guidelines, peer review, and stakeholder feedback, our group developed practice standards for pharmacists caring for patients with kidney disease in health care settings. The standards focus on activities that are part of direct patient care and also include activities related to public health and advocacy, population health, leadership and management, and teaching, education and dissemination of knowledge. These standards are intended to be used by a variety of professionals, from pharmacists starting new practices to practice managers looking to add a pharmacist to the clinical team, to create standardization in services provided. Patients with kidney disease represent a medically complex group of patients with high medication burdens that could benefit from clinical pharmacy services as part of the interdisciplinary care team to optimize medication use. The “Advancing American Kidney Health” executive order includes new value-based reimbursement models to be tested by the Center for Medicare and Medicaid Innovation beginning January 2021 and January 2022. Advancing American Kidney Health executive order poses opportunities for the inclusion of comprehensive medication management. Following an iterative process integrating input from a diverse expert panel, published standards, clinical practice guidelines, peer review, and stakeholder feedback, our group developed practice standards for pharmacists caring for patients with kidney disease in health care settings. The standards focus on activities that are part of direct patient care and also include activities related to public health and advocacy, population health, leadership and management, and teaching, education and dissemination of knowledge. These standards are intended to be used by a variety of professionals, from pharmacists starting new practices to practice managers looking to add a pharmacist to the clinical team, to create standardization in services provided. IntroductionChronic kidney disease (CKD) is a burdensome health condition and significant public health concern.1US Department of Health and Human ServicesHealthy people 2030.https://health.gov/healthypeopleDate accessed: November 19, 2021Google Scholar At least 1 in 7 Americans has CKD, and the disease disproportionately affects people of racial or ethnic minorities and those with low socioeconomic status.2US Department of Health and Human ServicesCenters for Disease Control and Prevention. Chronic kidney disease in the United States, 2021.https://www.cdc.gov/kidneydisease/publications-resources/CKD-national-facts.htmlDate accessed: November 19, 2021Google Scholar CKD is often the result of other chronic health conditions such as diabetes or hypertension and is progressive in nature. However, because of the lack of symptomatic disease until very late stages, it is often unrecognized or undertreated. Patients who progress to kidney failure require life-sustaining intervention with either dialysis or kidney transplant. Patients with kidney failure are medically complex and require an average of 11-12 home medications with even higher pill burdens to treat multiple chronic health conditions.3Chiu Y.W. Teitelbaum I. Misra M. de Leon E.M. Adzize T. Mehrotra R. Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients.Clin J Am Soc Nephrol. 2009; 4: 1089-1096Crossref PubMed Scopus (387) Google Scholar,4Manley H.J. Garvin C.G. Drayer D.K. et al.Medication prescribing patterns in ambulatory haemodialysis patients: comparisons of USRDS to a large not-for-profit dialysis provider.Nephrol Dial Transplant. 2004; 19: 1842-1848Crossref PubMed Scopus (128) Google Scholar Once receiving dialysis, patients have an average hospitalization rate of 1.6 admissions per year.5US Renal Data SystemUSRDS 2020 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MA2020https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.htmlDate accessed: November 19, 2021Google Scholar Medication regimens are frequently changed during hospital stays, and likewise, medication therapy problems have the potential to cause or contribute to hospital admissions. Patients may have trouble managing their medication regimens that include not only a high number of medications but also complex instructions and frequent changes.6Jang S.M. Parker W.M. Pai A.B. Jiang R. Cardone K.E. Assessment of literacy and numeracy skills related to medication labels in patients on chronic in-center hemodialysis.J Am Pharm Assoc (2003). 2020; 60: 957-962.e1Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 7Parker W.M. Ferreira K. Vernon L. Cardone K.E. The delicate balance of keeping it all together: using social capital to manage multiple medications for patients on dialysis.Res Social Adm Pharm. 2017; 13: 738-745Crossref PubMed Scopus (7) Google Scholar, 8Parker W.M. Jang S.M. Muzzy J.D. Cardone K.E. Multidisciplinary views toward pharmacist-delivered medication therapy management services in dialysis facilities.J Am Pharm Assoc (2003). 2015; 55: 390-397Abstract Full Text Full Text PDF PubMed Scopus (7) Google ScholarThe US government is a major stakeholder in the care of patients with CKD because most patients requiring dialysis and kidney transplant are Medicare beneficiaries regardless of age.9US Department of Health and Human ServicesCenters for Medicare & Medicaid Services. End-stage renal disease (ESRD).https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/End-Stage-Renal-Disease-ESRD/ESRDDate accessed: December 31, 2021Google Scholar In 2018, there were 554,038 patients on dialysis and 229,887 patients with a functioning kidney transplant in the United States.5US Renal Data SystemUSRDS 2020 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MA2020https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.htmlDate accessed: November 19, 2021Google Scholar In 2018 dollars, this equated to an average annual per patient cost of $93,191 for hemodialysis, $78,741 for peritoneal dialysis, and $37,304 for kidney transplant.5US Renal Data SystemUSRDS 2020 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MA2020https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.htmlDate accessed: November 19, 2021Google Scholar The executive order “Advancing American Kidney Health” was signed in 2019 and included the following 3 aims: (1) to decrease by 25% the number of new patients with kidney failure; (2) to have 80% of new patients with kidney failure undergo either home dialysis or a preemptive transplant; and (3) to double the number of organs available for kidney transplant.10US Department of Health and Human Services. Advancing American Kidney Health.https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/End-Stage-Renal-Disease-ESRD/ESRDDate accessed: December 31, 2021Google Scholar To accomplish these aims, new reimbursement models will be tested by the Center for Medicare and Medicaid Innovation beginning January 2021 for the End-Stage Renal Disease Treatment Choices model and January 2022 for the Kidney Care Choices model and will include patients with CKD who have not developed kidney failure.11US Department of Health and Human ServicesCenters for Medicare & Medicaid Services. Kidney care choices (KCC) model.https://innovation.cms.gov/innovation-models/kidney-care-choices-kcc-modelDate accessed: December 31, 2021Google Scholar,12US Department of Health and Human ServicesCenters for Medicare & Medicaid Services. ESRD treatment choices (ETC) model.https://innovation.cms.gov/innovation-models/esrd-treatment-choices-modelDate accessed: December 31, 2021Google Scholar All models are value-based and focus on cost sharing between Medicare and the participants as briefly described in Table 1.13Jain G. Weiner D.E. Value-based care in nephrology: the kidney care choices model and other reforms.Kidney360. 2021; 2: 1677-1683Crossref PubMed Google Scholar The models are focused on preventive measures and outpatient interventions with opportunities for comprehensive medication management (CMM). In response to these new care models for patients with CKD, we herein present practice standards for pharmacists working with kidney patients to provide standardization in services provided.Table 1Advancing American Kidney Health models13Jain G. Weiner D.E. Value-based care in nephrology: the kidney care choices model and other reforms.Kidney360. 2021; 2: 1677-1683Crossref PubMed Google ScholarModelESRD Treatment ChoicesKidney Care Choices (KCC)Includes Kidney Care First and Comprehensive Kidney Care ContractingParticipantsNephrologists; dialysis facilitiesNephrologists; transplant centers; dialysis providersBeneficiariesPatients on dialysisPatients with CKD 4 and 5 and on dialysisQuality MeasuresESRD Quality Incentive ProgramESRD Quality Incentive Program; Depression Remission (NQF-1885); Increase in Patient Activation Measure (NQF-2483); Optimal ESRD starts; Decrease in total cost of careAbbreviations: CKD, Chronic kidney disease; ESRD, end-stage renal disease. Open table in a new tab Practice Standards DevelopmentPractice standards were developed using a multistep process with stakeholder feedback. A group of nephrology pharmacy experts was initially convened in April 2019 and established the Advancing Kidney Health through Optimal Medication is that with kidney disease medication management through care a pharmacist to medications are and for to Kidney Health Optimal Medication accessed: November 19, 2021Google Scholar on their caring for patients with kidney were for of practice were by the of the who as a between the practice group and the leadership The was to practice standards for in patients with kidney and chronic the of the Advancing American Kidney Health executive the group focused on practice standards for outpatient settings. Standards were developed using an iterative process that with a group of pharmacists from the United and working in and settings. The group used published standards American of Care and of and for ambulatory care pharmacy accessed: December 31, 2021Google the Patient Care for Comprehensive Medication Medication in Care patient care process for comprehensive medication management medication in care accessed: December 31, 2021Google published nephrology pharmacy practice standards for renal Standards of clinical practice for renal J Pharm. Google and clinical practice Kidney accessed: December 31, 2021Google Scholar as as other include but are not to and and practice to interventions for medication in outpatient patients with kidney disease be an for the standards, the Patient Care for Comprehensive Medication Medication in Care patient care process for comprehensive medication management medication in care accessed: December 31, 2021Google Scholar in 2018 and by the American of it with that the of to direct patient these nephrology practice standards also other services in the of public health and population leadership and and teaching, and dissemination of knowledge. the for and to patients with kidney disease. of and from the were was from nephrology and on group and by the The also with the leadership of education standards focused on and skills for pharmacy pharmacy and pharmacy working with kidney to such that the R. et standards for pharmacists comprehensive medication management in outpatient nephrology Full Text Full Text PDF Scopus (2) Google Scholar result in pharmacists to these practice Practice Standards in Kidney practice standards are and and related to these standards be in Patient in direct patient care activities comprehensive medication 1 and provide an of the of in outpatient patients with kidney disease for are in part of all direct patient care the pharmacist care patient social of health, and health working with an team a pharmacists often medication therapy problems the of kidney requiring with the care other or other health care may include management of health, or of Comprehensive Medication in as by the Patient Care for Comprehensive Medication and social and for social of and kidney kidney kidney and the and a Medication comprehensive medication be and include these of medications to of CKD in patients kidney on kidney of Care 2021; Full Text Full Text PDF PubMed Scopus Google such as and for for with medications that be or transplant for or to all on with to for patients on balance and for of kidney disease chronic kidney kidney kidney and kidney and of of and of CKD and the Care and a Medication with and with in of transplant kidney therapy the Care and input from the team, may include the with the with of health the medication and to to a of the medication to the patient has and and has to their the in the and a patient and the care CKD, chronic kidney the for and Kidney include or include during the and a Medication Kidney patients with or of medications with to dialysis and with to home peritoneal of pharmacist be on the of kidney and other frequent as CKD clinical practice for the and management of chronic kidney de et and of chronic kidney a Full Text Full Text PDF PubMed Scopus Google Scholar using the in the as a starting with as patients on dialysis, the End-Stage Renal Disease Quality Incentive medication medication are least Department of Health and Human ServicesCenters for Medicare & Medicaid Services. ESRD quality accessed: December 31, 2021Google Scholar In all it is that medications be following hospitalization or other of M. et management in kidney disease of the Disease Quality J PubMed Scopus Google in included in new value-based kidney care models are Medicare and through Medicare Renal Data SystemUSRDS 2020 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MA2020https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.htmlDate accessed: November 19, 2021Google Scholar be of the for Medicare and medication therapy management to patients in medication standards that the pharmacist will of treatment to kidney for health in patients with kidney and treatment The pharmacist is to be to the most through a variety of in kidney pharmacy education the of in the of pharmacy and pharmacy and in the of care to patients in kidney with the of Cardone K.E. K. Pai A.B. for of a medication for the of pharmacy J Health Pharm. 2020; PubMed Scopus Google these standards are toward with kidney patients also team care that includes a pharmacist Health and working with patients with kidney disease be to or in kidney health and health the of kidney disease and focus on and a of an care team, pharmacists a in for and and education of patients with or for kidney in and disproportionately with Diabetes Practice and of standards of care in PubMed Scopus Google Scholar pharmacists a in of kidney disease and preventive a of an care team, pharmacists be in health care the population of patients with kidney disease for a health care is or to care to quality K. M. et for kidney J Am Soc Nephrol. PubMed Scopus Google Scholar, Quality quality accessed: December 31, 2021Google Scholar, measures for with kidney and opportunities for kidney J Kidney Full Text Full Text PDF PubMed Scopus Google Scholar pharmacists in the following activities in this caring for patients with kidney disease in the and of related to the care of patients with or for kidney disease or medication to clinical and quality population are the pharmacists and the team to all patients to to socioeconomic or health and as in health care and may other pharmacy to their the of clinical in pharmacist and of pharmacy team may and that include other pharmacy pharmacy and or that services are and the health care et of the comprehensive medication management practice management a to and for practice Am Pharm. 2020; Scopus Google The practice management to comprehensive medication management in care Am Pharm. 2020; Scopus Google and of part of the interdisciplinary team, pharmacists a in education on kidney disease and medication management to a variety of other social other health care and patient care is of these result in care for the population of patients with kidney disease. of include the group education to patients and care on disease and education on pharmacy health care education on medication in patients with kidney disease; pharmacy pharmacy and pharmacy through as a clinical pharmacy and pharmacist education through education focused on and medication management in kidney disease; to all on the of kidney disease on minorities and and social of health and to medication are to the of medication therapy problems that care patients with kidney disease. the of pharmacist in patient care and a to the pharmacist clinical there are of pharmacist in outpatient nephrology et as team on patient and PubMed Scopus Google patient and health through pharmacy a to the US accessed: December 31, 2021Google Scholar kidney disease health care there are opportunities for reimbursement for pharmacist and pharmacists are not to be of dialysis care to the for Medicare and Medicaid End-Stage Renal Disease for Department of Health and Human ServicesCenters for Medicare & Medicaid Services. Medicare and Medicaid conditions for for end-stage renal disease and accessed: Scholar nephrology has the for pharmacist H.J. Garvin C.G. Drayer D.K. et al.Medication prescribing patterns in ambulatory haemodialysis patients: comparisons of USRDS to a large not-for-profit dialysis provider.Nephrol Dial Transplant. 2004; 19: 1842-1848Crossref PubMed Scopus (128) Google W.M. Ferreira K. Vernon L. Cardone K.E. The delicate balance of keeping it all together: using social capital to manage multiple medications for patients on dialysis.Res Social Adm Pharm. 2017; 13: 738-745Crossref PubMed Scopus (7) Google W.M. Jang S.M. Muzzy J.D. Cardone K.E. Multidisciplinary views toward pharmacist-delivered medication therapy management services in dialysis facilities.J Am Pharm Assoc (2003). 2015; 55: 390-397Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar and the of clinical pharmacist as part of the care A.B. and hospitalization in patients who a 2009; PubMed Scopus Google H.J. G. Weiner D.E. et medication therapy management and hospital in patients maintenance a J Kidney 2020; Full Text Full Text PDF PubMed Scopus Google Scholar these and in major clinical and cost include and medication therapy or R. M. in an outpatient a quality to decrease J Kidney 2017; Full Text Full Text PDF PubMed Scopus Google Scholar and kidney K. et care in kidney a 2021; PubMed Scopus (7) Google Scholar for patients with kidney M. A of the pharmacist interventions and during the PubMed Scopus (2) Google Scholar hospital of A.B. and hospitalization in patients who a 2009; PubMed Scopus Google Scholar and hospital patients on H.J. G. Weiner D.E. et medication therapy management and hospital in patients maintenance a J Kidney 2020; Full Text Full Text PDF PubMed Scopus Google Scholar and medication and transplant M. et health intervention and transplant medication a clinical J Am Soc Nephrol. 2021; PubMed Scopus Google Scholar with cost et hospitalization cost to the with a health intervention to medication in kidney transplant J Transplant. 2021; PubMed Scopus Google Scholar in care also pharmacists the care team as as high of patient care that comprehensive medication management their Am PubMed Scopus Google Scholar, J.D. et of an clinical pharmacist on the of in the care Am 2021; PubMed Google Scholar, R. Patient with services in a care 2021; PubMed Google Scholar published clinical practice the of pharmacists in kidney include the Kidney clinical practice for the care of kidney transplant J Transplant. 2009; Google Scholar the 2020 Diabetes and Diabetes 2020 Practice for Diabetes in Chronic Kidney 2020; Scopus Google Scholar the American Diabetes Standards of Care in Diabetes Diabetes Practice and of standards of care in PubMed Scopus Google Scholar and the American of et for the and management of high in executive a of the of the American of on Practice Am PubMed Scopus Google Scholar These standards not only pharmacist in kidney but also in care patients with of CKD care and require of and in the care of patients with kidney disease are described in the and from a variety of social of Social of health to care and the to to to and for of patients with kidney disease low socioeconomic and of home dialysis the health and social of health Americans in to with chronic kidney 2021; PubMed Google Scholar, R. M. et and ethnic in of and with home dialysis in the United Am Soc Nephrol. PubMed Scopus Google Scholar, G. Kidney in J Nephrol. 2015; PubMed Scopus Google Scholar A of was in patients who were or low socioeconomic with other an intervention to CKD L. et of and socioeconomic with patients with diabetes in the 2021; 4: PubMed Scopus Google Scholar to patients with kidney disease interdisciplinary to social of health with a of to to medication and of of new care models through Center for Medicare & Medicaid with health to provide care kidney and health as as on the of medication management to patients by opportunities to the care of patients with kidney disease. is our that the practice standards with and developed through the will pharmacists and care to in kidney practice to the health care These standards are to pharmacy American of American of and American and nephrology American of and National Kidney to of the of pharmacists in the care of patients with kidney disease. IntroductionChronic kidney disease (CKD) is a burdensome health condition and significant public health concern.1US Department of Health and Human ServicesHealthy people 2030.https://health.gov/healthypeopleDate accessed: November 19, 2021Google Scholar At least 1 in 7 Americans has CKD, and the disease disproportionately affects people of racial or ethnic minorities and those with low socioeconomic status.2US Department of Health and Human ServicesCenters for Disease Control and Prevention. Chronic kidney disease in the United States, 2021.https://www.cdc.gov/kidneydisease/publications-resources/CKD-national-facts.htmlDate accessed: November 19, 2021Google Scholar CKD is often the result of other chronic health conditions such as diabetes or hypertension and is progressive in nature. However, because of the lack of symptomatic disease until very late stages, it is often unrecognized or undertreated. Patients who progress to kidney failure require life-sustaining intervention with either dialysis or kidney transplant. Patients with kidney failure are medically complex and require an average of 11-12 home medications with even higher pill burdens to treat multiple chronic health conditions.3Chiu Y.W. Teitelbaum I. Misra M. de Leon E.M. Adzize T. Mehrotra R. Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients.Clin J Am Soc Nephrol. 2009; 4: 1089-1096Crossref PubMed Scopus (387) Google Scholar,4Manley H.J. Garvin C.G. Drayer D.K. et al.Medication prescribing patterns in ambulatory haemodialysis patients: comparisons of USRDS to a large not-for-profit dialysis provider.Nephrol Dial Transplant. 2004; 19: 1842-1848Crossref PubMed Scopus (128) Google Scholar Once receiving dialysis, patients have an average hospitalization rate of 1.6 admissions per year.5US Renal Data SystemUSRDS 2020 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MA2020https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.htmlDate accessed: November 19, 2021Google Scholar Medication regimens are frequently changed during hospital stays, and likewise, medication therapy problems have the potential to cause or contribute to hospital admissions. Patients may have trouble managing their medication regimens that include not only a high number of medications but also complex instructions and frequent changes.6Jang S.M. Parker W.M. Pai A.B. Jiang R. Cardone K.E. Assessment of literacy and numeracy skills related to medication labels in patients on chronic in-center hemodialysis.J Am Pharm Assoc (2003). 2020; 60: 957-962.e1Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 7Parker W.M. Ferreira K. Vernon L. Cardone K.E. The delicate balance of keeping it all together: using social capital to manage multiple medications for patients on dialysis.Res Social Adm Pharm. 2017; 13: 738-745Crossref PubMed Scopus (7) Google Scholar, 8Parker W.M. Jang S.M. Muzzy J.D. Cardone K.E. Multidisciplinary views toward pharmacist-delivered medication therapy management services in dialysis facilities.J Am Pharm Assoc (2003). 2015; 55: 390-397Abstract Full Text Full Text PDF PubMed Scopus (7) Google ScholarThe US government is a major stakeholder in the care of patients with CKD because most patients requiring dialysis and kidney transplant are Medicare beneficiaries regardless of age.9US Department of Health and Human ServicesCenters for Medicare & Medicaid Services. End-stage renal disease (ESRD).https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/End-Stage-Renal-Disease-ESRD/ESRDDate accessed: December 31, 2021Google Scholar In 2018, there were 554,038 patients on dialysis and 229,887 patients with a functioning kidney transplant in the United States.5US Renal Data SystemUSRDS 2020 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MA2020https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.htmlDate accessed: November 19, 2021Google Scholar In 2018 dollars, this equated to an average annual per patient cost of $93,191 for hemodialysis, $78,741 for peritoneal dialysis, and $37,304 for kidney transplant.5US Renal Data SystemUSRDS 2020 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MA2020https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.htmlDate accessed: November 19, 2021Google Scholar The executive order “Advancing American Kidney Health” was signed in 2019 and included the following 3 aims: (1) to decrease by 25% the number of new patients with kidney failure; (2) to have 80% of new patients with kidney failure undergo either home dialysis or a preemptive transplant; and (3) to double the number of organs available for kidney transplant.10US Department of Health and Human Services. Advancing American Kidney Health.https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/End-Stage-Renal-Disease-ESRD/ESRDDate accessed: December 31, 2021Google Scholar To accomplish these aims, new reimbursement models will be tested by the Center for Medicare and Medicaid Innovation beginning January 2021 for the End-Stage Renal Disease Treatment Choices model and January 2022 for the Kidney Care Choices model and will include patients with CKD who have not developed kidney failure.11US Department of Health and Human ServicesCenters for Medicare & Medicaid Services. Kidney care choices (KCC) model.https://innovation.cms.gov/innovation-models/kidney-care-choices-kcc-modelDate accessed: December 31, 2021Google Scholar,12US Department of Health and Human ServicesCenters for Medicare & Medicaid Services. ESRD treatment choices (ETC) model.https://innovation.cms.gov/innovation-models/esrd-treatment-choices-modelDate accessed: December 31, 2021Google Scholar All models are value-based and focus on cost sharing between Medicare and the participants as briefly described in Table 1.13Jain G. Weiner D.E. Value-based care in nephrology: the kidney care choices model and other reforms.Kidney360. 2021; 2: 1677-1683Crossref PubMed Google Scholar The models are focused on preventive measures and outpatient interventions with opportunities for comprehensive medication management (CMM). In response to these new care models for patients with CKD, we herein present practice standards for pharmacists working with kidney patients to provide standardization in services provided.Table 1Advancing American Kidney Health models13Jain G. Weiner D.E. Value-based care in nephrology: the kidney care choices model and other reforms.Kidney360. 2021; 2: 1677-1683Crossref PubMed Google ScholarModelESRD Treatment ChoicesKidney Care Choices (KCC)Includes Kidney Care First and Comprehensive Kidney Care ContractingParticipantsNephrologists; dialysis facilitiesNephrologists; transplant centers; dialysis providersBeneficiariesPatients on dialysisPatients with CKD 4 and 5 and on dialysisQuality MeasuresESRD Quality Incentive ProgramESRD Quality Incentive Program; Depression Remission (NQF-1885); Increase in Patient Activation Measure (NQF-2483); Optimal ESRD starts; Decrease in total cost of careAbbreviations: CKD, Chronic kidney disease; ESRD, end-stage renal disease. Open table in a new tab