By Chetan Paydenkar & Stephanie Pankow

As Value Based Care (VBC) begins to permeate throughout the healthcare industry beyond proof of concept, opportunities in previously unaddressed niche areas are coming under focus of the Center for Medicare and Medicaid Services (CMS).  

As evidence, recent legislation proposed by CMS that is applicable to the 57 nationally distributed Organ Procurement Organizations (OPOs) seeks to improve access to organ transplantation while also doubling the number of kidneys available for transplant by 2030.  Proposed changes, which go into effect in August, 2022, are based on value-based care principles with the dual objectives of delivering better quality care and reducing total cost by focusing on key performance metrics.  Populations that would benefit the most would be patients with end-stage renal disease (ESRD).  There are over 1MM individuals diagnosed with various stages of Chronic Kidney Disease (CKD), many with a Stage 5 ESRD diagnosis need a kidney transplant.  

While doing away with Donor Service Areas (DSA) completely, CMS legislation also holds OPOs accountable for improved performance along two key metrics to assess progress on an annual basis starting 2026.  These key metrics are:

1. Donation rate: Changing from a self-reported measure to one tracked centrally by CMS.  The numerator is defined as the number of actual deceased donors in the DSA who had at least one organ transplanted based on data reported to the OPTN.

2. Transplantation rate: Changes include exclusion of organs donated for research and seeks to incentivize acceptance of donors of all age groups.

Finally, CMS proposes to rank performance of the OPOs against these metrics annually with the bottom 75th percentile benchmarked against the top 25th percentile OPOs.  The lower performing OPOs will be required to develop action plans to improve performance and risk decertification if no improvements are realized within a specified time frame.  

The new legislation is likely to have far reaching impact on the competitive dynamics within the OPO industry.  Some key outcomes to expect include:

1. Focus on Evidence-based Practices and Workflows

As OPOs are held accountable to improved performance, emphasis will shift to real world evidence along two vectors.

First, the ability to identify and engage donors earlier on and more effectively in the donation process.  There will be renewed interest in workflow optimization within the organization in a bid to reduce waste and adopt efficient workflows.  The focus will be on individual, team and organizational level productivity as it contributes to achieving higher levels of performance per defined metrics.

Second, key operational capabilities of OPOs to streamline the transportation of organs post-procurement will come into focus.  The objective will be to reduce Cold Ischemic Times (CIT) and improve predictability in an effort to reduce discarded organs.  Timely data sharing across the ecosystem (OPOs, couriers, transplant centers) will drive an increase in successful transplants.  There is long term potential to understand how CIT correlates with patient quality of life based on clinical and real-world data generated in this domain.  

2. Greater Adoption of Innovative Technologies

Achieving improved performance will necessarily require adoption of technologies that emerged or were accelerated by a COVID world.  These include related tracking, touchless delivery, remote-monitoring and predictive analytics, all of which, have been widely utilized in other parts of the healthcare industry.  

Investing in new technologies will inevitably place increased financial pressures on the OPOs which are non-profit entities.  However, these investments should be viewed as strategic imperatives required to sustain the financial viability of the organization in a world where VBC permeates into all areas of the healthcare industry. This is where MediGO comes in and broad adoption of MediGO with its network effect on logistics and centralized communication between the OPO, Transplant Center, and Courier to optimize both the CIT; and the quality of the trip of the organ will become vital to improving outcomes

The proposed legislation by CMS will usher in a period of competition and innovation within the OPO industry leading to improved performance and access to organ transplantation.  

Executive management within OPOs need to start preparing now in order to be successful in this new environment.  Stay tuned for more on this topic in our blog series.