Health Plan Strategies for Better CKD Care: Moving Beyond Vendors

Health Plan Strategies for Better CKD Care: Why Moving Beyond Vendors Matters Now

Chronic Kidney Disease (CKD) is surging across the United States affecting over 37 million Americans and costing Medicare alone upwards of $114 billion a year. For payers, health systems, and especially primary care leaders, the old approach of patching care gaps with disconnected “point solution” vendors is running out of road. Today, the stakes are higher: fragmentation undermines outcomes, wastes resources, and frustrates everyone from physicians to patients. This is why executives must urgently rethink their CKD care strategy.

Enter the fresh perspective from Elizabeth Malko MD, Physician Executive Consultant whose hybrid background as a family physician, engineer, and payer executive offers a rare, 360-degree view. In her recent podcast appearance on the American Journal of Healthcare Strategy, Dr. Malko mapped a practical, partnership-driven path for health plans to finally deliver better CKD care, support providers, and move beyond the vendor treadmill. Her insight is a must-read for anyone invested in population health, risk-bearing arrangements, and the future of managed care.

What Makes CKD Care So Complex—and Why Do Old Solutions Fall Short?

The heart of the issue is this: CKD care demands robust, connected systems, but U.S. healthcare is designed around silos. Dr. Malko explains, “The system, the healthcare system, isn’t designed to make the connections that need to be made. Primary care physicians are actually uniquely suited for that… knowing what’s going on in the whole patient.”

In the U.S., care fragmentation is especially acute for chronic, high-complexity conditions like CKD and oncology. Primary care, despite being the only setting with a comprehensive patient view, is chronically under-resourced. “Internationally, all of the first world countries… are very, very much primary care based. And, unfortunately, most of all of them have significantly better health outcomes overall when you look at a population than the United States does,” Malko notes.

Why does this matter for health plans and executives today?

• CKD patients often see multiple specialists, leading to uncoordinated care and medication risks.
• Social determinants of health (SDOH) and comorbidities further complicate the picture.
• Payers face runaway specialty costs—“The complex conditions in specialty care is costing payers 10-20 fold what they’re spending on primary care.”

The bottom line: the status quo creates unnecessary friction, poor outcomes, and sky-high costs, exactly what value-based care is meant to address.

Is Primary Care the Solution—or Are Payers Missing the Mark?

Primary care is essential to effective CKD management, but investment has lagged. Yet, Dr. Malko pushes back on the notion that payers neglect primary care. “Most health plans have been, continually year over year, increasing the reimbursement rate to primary care while holding specialty rates flat… Health plans do absolutely recognize the value of primary care.”

However, deep-rooted payment inequities persist. Medicare Payment Advisory Commission (MedPAC) sets CMS rates that still favor specialty care. The U.S. lags behind international peers in primary care investment, even though outcomes depend on it. “The only one who knows what’s going on is the health plan because we see all the claims… Health plans are building provider portals that are really helping to create some of that information flow back to the primary care physicians,” she adds.

Key ways health plans are evolving:

• Risk-based contracts with PCPs, incentivizing quality and outcomes
• Provider portals and data sharing, allowing PCPs to track patient care across settings
• Case management and member navigation for complex cases

Still, there are regulatory limits—for example, health plans cannot share certain behavioral health or HIV data due to federal rules. Even so, the direction is clear: successful CKD care starts with empowering primary care as the “quarterback.”

Why “Vendors” Don’t Solve CKD—And What Makes a True Clinical Partner?

Dr. Malko is adamant: health plans should stop thinking in terms of “vendors” and start demanding true clinical partners. Here’s why—and what executives need to change.

“When I look for a vendor, or a clinical partner, I’m looking for someone who brings a solution that as a health plan I’m never going to find by myself… I am looking for a partner, I am looking for someone who is in some way, shape, or form, going to have some skin in the game around outcomes.”

The old vendor model—contracting for transactional, SLA-based services—doesn’t deliver meaningful change in CKD or other high-complexity domains. The new imperative is to co-create outcome-driven partnerships, where the partner:

1. Delivers capabilities the health plan cannot build in-house
2. Has “skin in the game”—risk-based contracts tied to measurable outcomes
3. Collaborates directly with plan leadership, providers, and IT
4. Is accountable for real impact, not just activity or engagement metrics

As Dr. Malko summarizes: “It was very transactional and not based on a collaborative partnership and an outcome. And so I think that model has shifted dramatically nationally.”

What to look for in a clinical partner:

• Proven outcome metrics (e.g., reducing ER utilization, improving quality scores)
• Willingness to share risk or guarantee results
• Ability to operate across multiple geographies and disease states
• References from similar-sized health plans

Questions for executives to ask before signing:

• Is this a point solution or an integrated clinical partner?
• Will this partner take risk for outcomes, not just processes?
• Can they demonstrate value with real data—across states and populations like mine?

How Should Health Plans Select—and Integrate—the Right Clinical Partner?

Selecting a CKD partner isn’t like buying software; it’s a strategic, clinical decision that must involve the C-suite and clinical leadership. Dr. Malko is clear: “The Chief Medical Officer is part of the C-Suite and any clinical vendor decision making ultimately really has to have a strong thumbprint of the Chief Medical Officer.”

The process should look like this:

1. Clinical vetting by the Chief Medical Officer (CMO)—responsible for cost, quality, and outcomes, not just finance.
2. Total Medical Expense Committee review, ensuring solutions tie to real member and business value.
3. IT, provider, and business team alignment—especially around data integration and interoperability.
4. Reference and geographic checks—the partner must have experience in your markets and with your provider types.

Malko warns against the trap of the “vendor management team” treating clinical partnerships like SaaS procurement: “In this case you’re saying it’s a clinical partner and you need that involvement… I would never hire a vendor under those circumstances. This is completely different. And it does take some work on the CMOs part to really get the CEO and the CFO to understand this very, very different dynamic.”

Best practices for integration:

• Start with larger or at-risk PCP groups for maximum early impact.
• Standardize the data set provided to the partner—“We are not going to spend hours, days, weeks, creating the data set that you want… If you want to work with us, you’re going to have to figure out how to use it.”
• Expect and plan for IT “glitches”—but prioritize collaboration over blame.

What Does Partnership Look Like for Providers? Primary Care’s Perspective

For providers, especially primary care, a new clinical partnership can feel like “just another entity telling you how to practice medicine.” Dr. Malko gets it—her perspective as a former family physician grounds her approach in reality.

“Your initial response is, yeah, no, not interested. Thanks anyway. Because the last thing you need is somebody else telling you how to practice medicine. Right? And that, that is the normal, the normal response.”

Yet, the right partner—especially in CKD—can be a gamechanger. What actually works?

• Direct engagement: CMO or provider relations teams work with both the clinical and business leadership of practices, especially larger groups.
• Early identification and referral: Helping PCPs find CKD patients early and connect them with nephrologists before complications arise.
• Case management support: Assisting with follow-up, member navigation, prior authorization, and transitions of care.
• Voluntary collaboration: “If you want our help, we’re here. That was a very compelling argument to me as a primary care physician.”

“It is the provider who is taking care of the patient. And our job is not to get in the way of that and to the extent that we can to provide them resources and support in order to do so.”

CKD, Oncology, and the Limits of the Vendor Model

Not every disease state warrants the same approach. According to Dr. Malko, CKD and oncology are unique—their complexity and fragmentation demand a true partnership model.

• CKD: Early nephrologist involvement, med reconciliation, SDOH support, and comorbidity management are all essential—often beyond the bandwidth of most primary care practices.
• Oncology: Primary care plays a key role early and late in the journey, but the specialist “owns” much of the care in between. Payers and partners must facilitate smooth handoffs and data sharing.
• Migraine/neurology: Some complex conditions can be managed more in primary care; others cannot. Don’t apply one-size-fits-all solutions.

“You can’t be having 12 vendors… calling a PCP practice and saying, Hey, we can help you with this. That doesn’t make any sense. But I think nephrology and oncology in particular are kind of two outliers.”

Lessons from Healthmap Solutions: Building a Model That Works

Healthmap Solutions, where Dr. Malko serves as Physician Consultant, exemplifies this new approach. Rather than selling another point solution, Healthmap Solutions operates as a clinical partner—aligning with both payers and providers to close CKD care gaps.

“One of the things that I’ve found unique about Healthmap is lots of clinical partners or vendors work with primary care physicians on diabetes or this or that, but on really actually working on that connection between the nephrologist and the primary care physician, you don’t see that very often and I think that’s really one of the strengths that Healthmap has brought to the table.”

Their model centers on:

• Engaging PCPs and nephrologists directly
• Providing actionable data and case management
• Aligning incentives around patient outcomes—not just activity
• Supporting both members and providers through high-complexity transitions

The result? Fewer missed diagnoses, earlier intervention, less duplication, and a more sustainable care model for high-cost CKD populations.

Actionable Takeaway: From Vendor to Partner—A Blueprint for CKD Strategy

The prescription for better CKD care is clear: stop treating population health as a series of disconnected vendor purchases. Start building true clinical partnerships that put outcomes, collaboration, and primary care at the center. For executives, this means:

• Insist that every CKD “vendor” be able to operate as a true clinical partner—willing to share risk and outcomes, not just processes.
• Involve your CMO, clinical, IT, and business teams early—this is not procurement, it’s strategy.
• Prioritize partners who strengthen the PCP-nephrology connection and can operate across your populations and geographies.
• Streamline the data burden—standardize what you provide, and demand that partners adapt.
• Be prepared to say “no” to point solutions that fragment care or add complexity.

As Dr. Malko concludes, “We are not hiring another vendor. We’re hiring a clinical partner who is in as deep as we are in getting the outcomes that we need. And by the way, these outcomes really matter to the member and they matter to our bottom line.” Success demands partnership, not just procurement. The future of CKD care—and U.S. healthcare’s next leap forward—depends on it.