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.
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?
The bottom line: the status quo creates unnecessary friction, poor outcomes, and sky-high costs, exactly what value-based care is meant to address.
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.
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.”
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:
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.”
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:
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.”
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?
“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.”
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.
“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.”
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:
The result? Fewer missed diagnoses, earlier intervention, less duplication, and a more sustainable care model for high-cost CKD populations.
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:
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.
