Health Equity in Kidney Care

A: I attended medical school at the University of Colorado and then completed my internal medicine residency and nephrology fellowship training at the University of Washington. At these institutions I had the opportunity to learn from exceptional nephrologists. I chose nephrology as a subspecialty because of the opportunity to have long-term care relationships with patients and their families, the need for complex medical decision-making, and interesting pathophysiology. While I was at the University of Washington, I also completed my Master of Public Health degree.

I have had a longstanding interest in the measurement of healthcare quality. I was on the National Quality Forum Renal Standing Committee and had the opportunity to serve as a committee co-chair.

A: It was, and still is, the opportunity to influence and improve care for people with kidney disease. The potential scale of impact is unique to large healthcare providers.

A: I joined the company in 2016 as Vice President for Epidemiology and Research in the Fresenius Medical Care North America Medical Office. In 2020, I was appointed to Global Head of Population Health. My roles and responsibilities continued to evolve until my promotion to Senior Vice President and Head of Population Health and Medicine for the Global Medical Office in January 2024.

While my roles and responsibilities have evolved over the years, I have always provided clinical and epidemiologic expertise within the organization. My current responsibilities include further development of global healthcare quality and safety measures, collaboration across the organization to develop and implement a global health equity strategy, collaboration with U.S. academic institutions on research, and support of organizational sustainability efforts.

A: Health equity and reducing health disparities is important across all healthcare fields and settings. It's well recognized throughout the world that health disparities exist, and there are many factors that lead to these observed differences. The question we should be asking ourselves at Fresenius Medical Care is, how do we as a healthcare organization meaningfully address and reduce known health and healthcare disparities? Healthcare organizations have an important and critical role in reducing health disparities and advancing health equity.

As an example, in the U.S. there has been a focus on increasing the overall use of home dialysis, yet disparities have not been adequately addressed and much more work is needed to reduce differences in the use of home dialysis based on socioeconomic status or race and ethnicity.

A: First, let me describe some of the work in the U.S. We're creating the U.S. Health Equity Strategic Plan, which will be adopted by every facility in the U.S. We will use our demographic and clinical data to identify and address disparities and make those insights available at the clinic level, not just at a regional or national level. Later this year, clinics in the U.S. will be able to use clinic-level data to identify disparities in their population under care and use this information to improve the quality of care.

One of the initiatives I'm most excited about is our plan to launch a national quality improvement project focused on lowering food insecurity in our end stage kidney disease population under care in the U.S. This will be a multiyear effort where we'll be disciplined in screening and developing interventions to lower food insecurity. These activities are foundational to fulfilling the End Stage Renal Disease Quality Incentive Program Facility Commitment to Health Equity.

In the rest of the world, we will first focus on creating a global steering committee responsible for the governance of FME [Fresenius Medical Care] global health equity initiatives and a global data framework for identifications of health disparities.