An Executive Perspective on Prevention, Care Coordination, and the Evolving Role of Nephrology Practices
The U.S. Department of Health and Human Services (HHS) has released its 2026 Kidney Care National Plan, outlining a national strategy to prevent kidney failure, improve dialysis care, expand patient choice, and strengthen the nation’s kidney transplantation system.
Having worked alongside nephrology practices for years and cared for patients with chronic kidney disease (CKD) and kidney failure in clinical settings, I find this plan both encouraging and long overdue.
Our experience working with nephrology practices and caring for patients with complex kidney disease has taught us an important lesson:
Some of the greatest opportunities to improve patient outcomes exist beyond the physician’s examination room.
Clinical expertise is essential, but it does not guarantee that every patient receives timely follow-up, coordinated treatment, and the support needed to manage a complex condition over time.
People with kidney disease may be managing several chronic conditions, taking multiple medications, and navigating care across different providers and settings.
The challenge is ensuring that the care patients need continues beyond the scheduled appointment.
That is where an important opportunity lies.
The Price of Discovering Kidney Disease Too Late
According to HHS estimates, approximately 37 million U.S. adults have chronic kidney disease, with an estimated 87% unaware that they have the condition.
These figures highlight a significant challenge:
Kidney disease can progress without noticeable symptoms in its earlier stages. Some people may not discover that their kidney function is declining until testing identifies a problem or the disease has advanced.
Diabetes, high blood pressure, and cardiovascular disease are among the conditions that make kidney health particularly important to assess.
Yet identifying people at risk is only part of the challenge. They must also receive appropriate evaluation and follow-up.
For healthcare leaders, this raises an important question:
How reliably are people at increased risk being identified and connected to the appropriate care?
HHS has positioned early intervention at the core of its national agenda. Among the key initiatives outlined in the HHS Fact Sheet is a proposed systematic review of evidence regarding targeted screening for high-risk populations.
This is a proposed policy direction, not a new universal screening requirement. Nevertheless, it reinforces the importance of examining how current clinical processes identify people who may benefit from evaluation.
As noted by the National Kidney Foundation (NKF), prioritizing early detection can create an opportunity to slow disease progression and address risk factors before kidney disease advances.
Depending on the individual’s condition, appropriate management may include monitoring kidney function and urine albumin, controlling blood pressure and blood glucose, reviewing medications, and considering evidence-based treatments.
Identifying CKD creates an opportunity to act, but patients also need appropriate treatment, medication follow-up, and monitoring over time.
A diagnostic finding is merely the entry point to a clinical care pathway, not the solution to the problem. The clinical opportunity depends entirely on what happens next.
Bridging the Gap: Finding Kidney Disease Is Only the First Step
Consider a patient with diabetes whose laboratory results suggest declining kidney function.
The findings may prompt further evaluation, changes in treatment, additional testing, or referral to a nephrologist, depending on the clinical circumstances.
Each step requires a decision and, often, coordination among members of the care team.
The treating clinician must interpret the findings, determine the appropriate response, communicate the plan, and establish the necessary follow-up.
That process may involve primary care clinicians managing diabetes and hypertension, nephrologists addressing kidney-specific concerns, and other specialists treating related conditions. Medication decisions made by one clinician may also affect the patient’s broader treatment plan.
The difficulty is not necessarily a lack of clinical knowledge. It is ensuring that important information and decisions carry forward across appointments, providers, and care settings.
A patient’s condition may change after a visit. Medication regimens may need reassessment as kidney function evolves.
Follow-up laboratory tests may be necessary to evaluate treatment response. Referrals may need to be completed, and patients may need help understanding changes to their care plans.
These responsibilities cannot always be addressed during a single appointment.
Practices need clear processes to flag concerns, assign follow-up responsibility, coordinate care, and confirm that necessary actions are completed.
The goal is not to monitor every patient constantly, but to ensure that changes in their condition and outstanding care needs are addressed between appointments
The appropriate approach will differ from one patient to another. Some people may need routine follow-up, while others may require more frequent assessment, additional coordination, or timely intervention when their condition changes.
Clinical judgment, disease severity, individual risk, and patient circumstances should guide those decisions.
For nephrology leaders, the operational question is whether the practice has reliable processes to support these different needs.
Care coordination, in this context, is more than an administrative function. It is part of how clinical decisions become ongoing care.
Beyond Prevention: Dialysis, Patient Choice, and Transplantation
The HHS Kidney Care National Plan extends beyond preventing kidney failure.
It addresses the treatment options available to people with kidney failure and the systems through which they access those options.
These challenges differ from early disease detection, but they share an important consideration: improving kidney care requires attention to how services are organized, accessed, and delivered, not just to the clinical decisions made during an appointment.
Expanding options in dialysis care
For people who develop kidney failure, dialysis can be lifesaving.
However, the treatment options available, the settings in which care is delivered, and the practical demands of treatment all affect a patient’s experience.
HHS proposes examining regulatory barriers and opportunities to expand access to home-based dialysis and other care settings. The plan also emphasizes patient choice.
The proposal also focuses on the structure of the dialysis market, including regulatory barriers to new providers, access to home-based care, and opportunities for greater competition. For healthcare leaders, these potential changes raise questions about how their organizations support informed patient choice and respond to an evolving treatment landscape.
Home dialysis may offer greater flexibility for some people, but it is not suitable for everyone. Clinical circumstances, patient preference, training, and available support all influence whether it is an appropriate option.
Expanding choice therefore involves more than making a treatment available. Patients need clear information, appropriate evaluation, and support as they consider and transition to the treatment best suited to their circumstances.
The proposed policy reviews may influence the environment in which dialysis services are delivered. They do not mean that every practice must immediately adopt a new treatment model. They do, however, make access, choice, and the practical delivery of care important issues for kidney care leaders to follow.
Strengthening the transplant system
Transplantation is another major priority in the HHS plan, which proposes reforms to strengthen oversight and accountability, modernize the Organ Procurement and Transplantation Network (OPTN), and support living kidney donation.
For eligible patients, a kidney transplant can offer an alternative to long-term dialysis.
While national reforms address system-level barriers, nephrology practices can examine how effectively they refer eligible patients, communicate next steps, and support them through the transplant evaluation process.
Patients may need to navigate referrals, clinical evaluations, eligibility decisions, and communication among the organizations involved.
Some of the barriers in this process require system-level action. Individual nephrology practices cannot independently resolve regulatory challenges or reform the national transplant infrastructure.
Practices can, however, examine how effectively they support patients through the parts of the pathway within their control. This may include helping patients understand the evaluation process, making appropriate referrals, and communicating about next steps.
The distinction matters: healthcare organizations cannot control every barrier patients encounter, but they can assess whether their own processes help patients move through the care pathway.
Taken together, the plan’s three priorities; prevention, dialysis care, and transplantation address different points in the course of kidney disease.
Each requires clinical expertise, but each also depends on whether patients can access appropriate services and navigate the care system effectively.
4 Strategic Questions Healthcare Leaders Must Ask Today
The Kidney Care National Plan sets out policy directions that HHS intends to advance or explore. Its proposals should not be treated collectively as new requirements already in effect.
Healthcare leaders do not need to wait for every policy detail to be finalized, however, before examining how their current care processes support people with kidney disease.
Four questions provide a useful starting point.
1. Are we identifying people who may benefit from earlier evaluation?
Review how the practice identifies people at increased risk of CKD and how abnormal findings are evaluated and followed up. Consider whether responsibilities are clear when testing occurs outside the nephrology practice or results arrive from another care setting.
The aim is to determine whether current processes align with clinical guidance and the needs of the population being served.
2. What happens after a clinical concern is identified?
Identifying a problem is only the first step; the necessary follow-up must also happen.
Leaders can examine how the practice tracks outstanding tests, referrals, treatment changes, and follow-up appointments when these are clinically indicated. Where a process depends on someone remembering to follow up, consider assigning responsibilities clearly.
3. Can our teams coordinate care across conditions and settings?
People with CKD often have other chronic conditions and may receive care from several clinicians.
Leaders should examine how relevant information is shared, how medication-related concerns are communicated, and how responsibilities are divided among primary care, nephrology, and other members of the care team.
The objective is to ensure that important clinical information reaches the people who need it and that patients are not left to coordinate every part of their care themselves.
Medication management is one practical part of this coordination.
Pharmacist-led support can help identify medication-related concerns, support adherence, and communicate relevant issues to the prescribing team.
For nephrology practices, the key is ensuring that medication-related needs are addressed as part of the broader care plan.
4. Can our current model sustain the work?
Consistent follow-up and coordination require time, clear workflows, appropriate staffing, and reliable information.
Leaders should consider whether existing processes allow the team to identify patients who need attention, complete appropriate follow-up, and document the actions taken.
Technology may support this work, but adopting a software alone does not establish an effective care process.
It is important to understand who reviews information, what prompts action, who is responsible for responding, and how the response is documented.
The financial model matters as well.
HHS recognizes that incentives may not always adequately support prevention, particularly when the costs and benefits of preventive care fall on different parts of the healthcare system.
As policy proposals develop, organizations will need to assess how emerging payment approaches affect their ability to sustain preventive and coordinated care.
These questions are not a checklist of new federal mandates. They are a starting point for assessing whether existing care processes are equipped to support patients and respond to the direction kidney care policy is taking.
Translating National Policy Into Everyday Clinical Practice
The HHS Kidney Care National Plan sets out an agenda for earlier intervention, greater choice in dialysis care, and reform of the transplant system.
Turning those priorities into better care will require both system-level policy changes and reliable processes within healthcare organizations.
Nephrology leaders can examine how their practices identify patients who need attention, coordinate medication-related care, track referrals, and ensure appropriate follow-up.
Not every barrier can be resolved at the practice level, but organizations can strengthen the processes within their control.
The central question is whether the care model can translate clinical decisions into appropriate, coordinated action over time.
Kidney care does not begin and end with a scheduled appointment. What happens between visits is part of the care itself.
References
1. U.S. Department of Health and Human Services. (2026, October 20). HHS launches landmark national plan to transform kidney care in America. https://www.hhs.gov/press-room/hhs-launches-kidney-care-national-plan.html
2. U.S. Department of Health and Human Services. (2026, October 20). Kidney Care National Plan fact sheet. https://www.hhs.gov/press-room/kidney-care-national-plan-fact-sheet.html
3. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Identify and evaluate patients with chronic kidney disease. https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/kidney-disease/identify-manage-patients/evaluate-ckd
4. National Institute of Diabetes and Digestive and Kidney Diseases. (2016, October). Managing chronic kidney disease. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/managing
5. National Kidney Foundation. (2026, October 20). NKF: Prevention must be central to the future of kidney care. https://www.kidney.org/press-room/nkf-prevention-must-be-central-to-future-kidney-care
