Leading Integrated Kidney Care Entities of the Future.

The leaders of 20th century kidney failure treatment took chances; 21st century leaders of integrated kidney care must do the same. Some risks are clinical, some are organizational, and some are financial. Decent and constructive leadership entails humility. A working practitioner is a better leader. Effective leaders empower their employees and collaborators to lead and encourage them to work together. Integrated kidney care leadership supports exchange of ideas within and among organizations, uninhibited by competitive considerations. ESRD Seamless Care Organizations lead us toward the kidney care of the future; they will be strengthened by expansion to include patients who have advanced kidney disease not yet requiring renal replacement therapy and patients treated by transplant. Adjustment of reimbursement policy to realign incentives will be essential to the long-term success of care coordination. Population health management, with downside risk for participating organizations, is the future of integrated kidney care. Critical goals for integrated kidney care are to delay or avoid dialysis; increase use of home dialysis, transplantation, nondialytic care, and hospice; and to improve end of life care. It's about the patients, stupid.