Interview with Joyce Jackson, Northwest Kidney Centers

Joyce Jackson is the CEO and President of Northwest Kidney Centers, the country’s third largest non-profit dialysis provider. The Northwest Kidney Centers serves patients in King and Clallam Counties, providing over 268,000 dialysis treatments per year. Jackson recently spoke with State of Reform to discuss the organization, collaboration across health care silos, quality of care, and Northwest Kidney Centers’ goals moving forward.

This interview has been edited for clarity and length.

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Emily Boerger: Tell me a little about Northwest Kidney Centers and its over-arching mission.

Joyce Jackson: “Northwest Kidney Centers is a healthcare provider. We provide direct patient care to nearly four out of five people in King County who have kidney failure and need dialysis to stay alive. We also provide care to 100 percent of the people that live in Clallam County. We were founded in 1962 as the world’s first dialysis organization. Often that gets translated as the first in the U.S., but we are actually the first in the world.

Dialysis is really a remarkable therapy. However, you’ll see that a lot people struggle with kidney failure because of diabetes or high blood pressure. They often have a lot of other conditions that they’re struggling with. So, while dialysis cleans the blood, which is its basic function, our patients have a lot of complications and there’s nothing like 24/7 kidneys so a lot of them don’t feel great even after a four-hour treatment. It’s tough to get back to vibrancy of health and that’s a difficult challenge that we try to help people with.”

EB: What does Northwest Kidney Centers do beyond dialysis treatments to help bring back that vibrancy of health? What efforts are being made to improve patient quality of care and quality of life?

JJ: “I’m very pleased and proud of the unique services that really qualify us as living out our non-profit mission. Of course, being non-profit is not a financial term; it’s a legal term. It means we’re owned by the community, not by shareholders or a private individual. And I think that means that a non-profit really needs to be thinking about, what are we doing to advance communities’ kidney health in our case.

But to your question, what do we do that’s unique and different, I’ll start with a service that we’ve had since the very beginning, since 1962. We provide care for people that need extra services, we call it special care. Normally people sit in a recliner for four hours [during treatment]. But when people are frail, or they live in a nursing home, they need extra TLC. So, we have special care services where we have a higher level of staffing, and we have beds and supportive services for them.

As an outsource of that, last year we launched the nation’s first palliative care program for outpatient dialysis patients.  Palliative care is supportive care to improve quality of life. And we have a physician who is a nephrologist and a palliative care doctor, certified in both, a nurse and social worker, and they are a team that helps dozens of people that really have challenges with pain, sleep issues, depression, and other things that really effect their quality of life.

Third, we have a very robust chronic kidney disease program. We provide free classes and individual consultations for people who are facing serious kidney disease and looking at kidney failure and thinking, “what are my options?”

EB: I also want to talk about the ways in which Northwest Kidney Centers collaborates on care. In what ways does your organization engage in collaborative care and collaborative work?

JJ: “We’re deeply rooted in our community… and we continue to foster open dialog and sharing with hospitals and major health clinic partners. Those include Polyclinic, Swedish Medical Groups, Virginia Mason physicians, UW physicians, but also all the hospitals in our region.

So, how do we collaborate? Well the first thing we do is share information back and forth about our common patients. About three years ago, we joined the EDie program, which is a statewide emergency department information exchange… So, when one of our patients goes to an emergency department, immediately, because they’re in the system when they’re registered in the emergency department, we are pinged, we get a fax, we get a notification… EDie automatically informs us when someone goes to the Emergency Department, when someone is admitted, and they are discharged. This has filled a huge gap.

Another recent leap forward is that all the hospitals in Western Washington, in King County and Pierce County, they’ve all allowed our staff to get credentialed so we can “read only”, or look at the electronic medical records and see what’s happening to our patients when they’re in the hospital or discharged.

So those are two examples, where on a day to day basis we can collaborate with the hospitals to better coordinate care for our patients when they’re going in, and going out, and kind of keep them from being re-admitted. A major goal for all of us is avoiding any unnecessary admissions to the hospital.”

EB: What about collaboration outside of the Northwest?

JJ: “Sure. The Nonprofit Kidney Care Alliance started in 2010 and it’s made up of the National Nonprofit Dialysis Program. The non-profits are a minority; dialysis nationwide is pretty much almost all for profit and there are actually two large companies that care for about 70 percent of all the patients in the United States. We feel we have a unique position being non-profit and deeply rooted in the community and so we collaborate with five non-profits including the largest one in the country, out of Nashville, one out of New York City, one out of Cleveland, ourselves, and one out of Baltimore.

We collaborate with them weekly, we share advocacy agendas, together we speak to Congress and to the regulators of CMS about issues that will advance patient care, and we share quality learning and challenges… We’re all very involved in home dialysis and transplant and so we will be talking about how to advance those important options. So it’s a very collaborative, national group that I’m so pleased is around.

EB: Looking Forward, what are your goals for the Northwest Kidney Centers?

JJ: “We are the kidney people. We want to educate the public about kidney disease and slow kidney disease. We actually have a collaboration with the American Diabetes Association because the leading cause of kidney failure today in the United States is diabetes. So if we can slow diabetes, we can slow kidney disease. And we truly do want to put ourselves out of business, that’s what a good non-profit wants right? It’s to eliminate the need.

Our plan for the future is to continue our mission to provide patient care, education, and research. And we’ve identified four big goals: to grow bigger, to grow together (and that’s all of those alliances and coordination we’ve talked about), to perform better, and then to care better (and that’s the renal supportive care, the palliative care, the transplant programs).

The only thing I haven’t talked to you about is growth. And we have a very aggressive growth strategy because there is such a need for dialysis care in this state.  So, we’re looking at adding 12 percent more capacity through various applications through the state to add more centers. Actually, this year we opened two centers in Federal Way and soon we’ll open one in Fife in Pierce County. We’re expanding our Kent facility by 50 percent, we’re opening a unit in Rainer Beach, we’re adding more functional capacity in West Seattle-Burien, and then we have four applications into the state today to expand in Everett, North Seattle, and SeaTac, and Enumclaw.