DaVita's New Home CMO Considers How to Increase Access to Home Dialysis
Head shot of Dr. Mihran Naljayan, DaVita's chief medical officer for Home Modalities
Dr. Mihran Naljayan, chief medical officer for Home Modalities at DaVita

For Dr. Mihran Naljayan, the two keys to increasing patient access to home dialysis are clear—health equity and education.
 

Recently named DaVita’s new chief medical officer (CMO) of Home Modalities, Dr. Naljayan is on a mission to transform the way nephrologists and the kidney care industry help ensure home dialysis is a viable option for patients.


He’s wasted no time identifying where he wants to focus his new role:


“How do we ensure equitable access to home dialysis for more patients around the country?” Dr. Naljayan asks. “And not only access to home, but how do we keep them on home as their modality of choice using an equitable lens?”


Dr. Naljayan estimates 50% of home patients are unable to continue dialyzing at home each year, and about 35% stop due to what he believes are “controllable risk factors,” such as—adherence to treatment plans and the right diet and nutrition. Dr. Naljayan’s focus is on implementing the right systems to support and enable patients to continue treatment at home if that remains their modality of choice.  


Dr. Naljayan has already worked to unite physicians in addressing some barriers he sees in home therapy. He admits physicians can often feel like the challenges they face are unique to their own practices. Through his work with DaVita’s Home Physician Support Network, Dr. Naljayan has helped qualifying practices develop a better understanding of where gaps exist—and offered potential solutions for them. This has included providing education and resources on best demonstrated practices to fellow physicians, and identifying the local challenges in each market.


“Regardless of our environment, whether it’s urban or rural, academic or private, big group or small group; we all have very similar barriers that we have to overcome,” he says.


Since 2016—when Dr. Naljayan joined the Village—to now, DaVita saw a 35% increase in home hemodialysis (HHD) and peritoneal dialysis (PD) treatments. And in 2021, 15% of DaVita patients with end stage kidney disease (ESKD) treated at home for the first time, 2% more than the industry average.


For Dr. Naljayan and his team, this work is just the beginning.


He hopes to simplify the process in which patients utilize home therapies. This includes thinking about upstream awareness and modality planning. He points to patients working with their nephrologists to have modality conversations earlier. This can allow individuals to have dialysis accesses in place and ready to use before they need treatments—which can help reduce emergent, unplanned starts often called “crashes.”


This earlier planning and decision-making can mean patients are able to start on the best dialysis modality for them and could increase the number of individuals starting on either PD or HHD.


“It’s all about finding ways to optimize the home experience for our patients and giving them the opportunity to treat at home in a way that fits within their goals and lives,” Dr. Naljayan says. “Rather than dialysis dictating how they need to live, they dictate how dialysis fits into their life.”


Transforming Home Dialysis

When Dr. Naljayan took over the home dialysis program at Louisiana State University (LSU) School of Medicine in 2014, he admits he lacked robust experience in the field. He had previously worked with a few PD patients during his medical and nephrology fellowship in Boston, but he recognized he needed to learn more.
 

So, Dr. Naljayan began attending national meetings and sitting in on home dialysis sessions. And when he attended Home Day at the DaVita Physician Leadership Meeting his first and second years with DaVita, Dr. Marty Schreiber—DaVita’s Home CMO emeritus—presented.


“After the meetings I would go and talk to Marty [Schreiber], and he was just so kind and willing to teach and talk about ideas,” Dr. Naljayan fondly recalls.


Dr. Naljayan credits those early discussions with Dr. Schreiber for helping to spark and maintain his passion around home dialysis and the benefits it can have for patients. And when Dr. Naljayan launched his urgent start PD program at LSU, Schreiber provided thought partnership and inspiration.


A few years later, while attending a home dialysis meeting in New Orleans, Dr. Mark Shapiro— Group Medical Director and Vice President of Clinical Strategy and Innovation for DaVita—spoke to a group of nephrologists from across the country.


Dr. Naljayan recalls Dr. Shapiro comparing dialysis patients in his market to those in Louisiana. During the discussion, one of the local nephrologists pointed to a few barriers that can have an impact on modality choices—including education and socioeconomic resources.


It was in that moment Dr. Naljayan realized the nephrology community could overcome such obstacles. Each nephrologist may have different patients, but by providing education and considering each patient’s needs and understanding what they want out of dialysis, strides can be made.


Sure enough, by taking that into account, Dr. Naljayan’s team at LSU began to see more patients select home dialysis.


“Our patients didn’t change, they’re exactly the same,” he says. “It was because we changed our way of thinking around whether or not patients have the ability to treat at home.”


At its core, Dr. Naljayan’s vision for the future of home dialysis is centered around providing the highest quality of care for patients, regardless of their socioeconomic status, race or other social determinants of health.


“[We] have the ability to put home dialysis at the forefront of what we do for our patients,” he confidently says. “I believe my team and I together can truly change the face of dialysis in this country.”