The "Win-Win" (-win)- Affiliated Dialysis of California

queue soundtrack: DJ Khaled “All I do is Win-Win-Win” (ask your kids)

It has become a cliche’. “Think ‘win-win’…” I twitch as I flash-back to my days as a young sales professional, (before DJ Khaled was even born, I think), watching a slick-haired and slick-suited sales consultant filling our hearts with motivation and our minds with creative ways to peddle the wares of our employer (who incidentally paid a pretty penny to have the consultant stand in front of us and spew cliche’s). The slick consultant made it sound so much easier than it was in reality. Outside of that conference room, out in the real world, trying to find the “win-win” proposition in a sales pitch so often led to compromise that inevitably meant one of the parties at the table was winning less than what they had hoped, or less than the others involved— which is no win at all.

The problem is, a true win-win proposition is not spin. It’s not a pitch. It’s not a deal. Win-win starts at the core or the root of the product or service that is being presented. Win-win starts in the conceptual stage of the product or service, before it is ever “sold”. Or even better, at the birth of the company.

Home Dialysis Centers of Rancho Cucamonga, now doing business as Affiliated Dialysis of California is a perfect example of the “win-win” solution to a problem that transcends its own existence and that of its immediate customers. The very essence of the business, which has evolved into the first-of-its kind California provider of dialysis services to sub-acute and skilled care patients residing in nursing homes, is based on a win-win-WIN, whereby the community as a whole becomes a beneficiary of the growing success of the business.

Nursing Home dialysis as modality of treating patient-residents with kidney disease is growing in popularity across the United States. The torch of which has been taken up and rapidly expanded by Dialyze Direct, LLC along with an up-swelling of smaller providers with regional footprints, patient outcomes, mortality rates, and quality of life among the nursing home population inflicted with kidney failure have all improved exponentially as a result of this patient-centered alternative to the established standard. Historically, that previous “standard” involved transporting residents three times a week to outpatient centers for their dialysis treatments, causing elevated stress, missed meals, and compromised care plans. In California, prior to the efforts of Home Dialysis Centers of Rancho Cucamonga, a state that so often is a trend-setter in health care for the rest of the states to follow, the trail of dialysis in Skilled Nursing Facilities (SNF’s), was virtually un-blazed, and falling notably further behind the rest of the US.

For those not familiar with the California regulatory climate associated with dialysis in SNF’s, it is a spiderweb of overlapping governing entities and policies at the State level, resulting in an environment that is extremely restrictive to creative problem solving by healthcare providers. Since updated regulations were passed in 2017, no business had successfully “cracked the code” of on-site dialysis in the SNF in any meaningful way, as the perception prevailed that it was impossible for a business to break even while being compliant with all the State regulations and actually delivering adequate services to a meaningfully sized census. The unintended result of the State regulations (until recently) was that patients were “stuck” being transported from SNF’s three times a week, with all the aforementioned detriments to their health and welfare. And what about the more critical-care and sub-acute patients requiring dialysis? Forget about it. Only a handful of outpatient dialysis centers would even accept such patients, and the costs were astronomical because of the transportation costs, not to mention all the ancillary requirements such as the presence of a a patient care escort or even a Respiratory Therapist for a patient with a tracheotomy or ventilator. This led to a growing population of trach-vent patients in the hospitals and long-term acute-care facilities with no place to discharge that could accommodate their dialysis needs. The patients were stuck in the hospitals. And the payors— mostly MediCal managed care plans, funded in large part by taxpayer dollars— were stuck with extraordinary costs.

Enter Home Dialysis Centers of Rancho Cucamonga, d/b/a Affiliated Dialysis of California. Their owners decided to focus on this “stuck” population of sub-acute dialysis patients and developed a model that was both compliant to the overlapping State regulatory bodies (OSHPD and CDPH), and offered a favorable cost savings proposition to the payors and hospitals. They re-branded and re-birthed their more traditional home hemodialysis company and focused their investments and efforts on this new concept. The cultivation of the concept took years, but it is now bearing fruit. Having achieved the stamp of approval and licensing from the State oversight bodies for their model, focusing outreach on the hospitals and LTAC’s that were caring for these sub-acute dialysis patients, they are now saving the California healthcare system tens of millions of dollars (and growing) annually by providing bedside dialysis at affordable costs in the SNF setting for these patients with very specialized needs.

The business is “winning” with cost efficiencies and a new, robust market.

The payors (and taxpayers) and hospitals are “winning” as they now have a place for these patients rather than the expensive and indefinite “holding pattern” they were stuck with before.

And most importantly, the patients are winning. No more extended or indefinite stays in the hospital, waiting for an accommodating outpatient chair in the community to open up, with a coinciding sub-acute nursing home bed. And for those who were lucky enough to make it out of the hospital and into a care facility, no more transport to treatments three times a week in outpatient dialysis, which exhaust the latter part of the day (and the patient), and expose the patient needlessly to environmental hazards (I shouldn’t even have to mention COVID-19). Furthermore, no more missed meals or appointments with other providers involved in their care plans due to these extended trips to outpatient dialysis. The patients and their families are winning, with lower rates of infection, better mortality rates, and better quality of lives.

The wins keep on coming. Patients and their families- winners. State/Taxpayers/Healthcare System- winners. Hospitals and Skilled Nursing facilities- winners. Provider/Business- winners.

For Affiliated Dialysis of California, “win-win” is not just a cliche’. Because it’s not just a sales pitch. It’s at the very core of their model, which was developed to solve a patient care problem in California, with business efficiencies in mind. This is a fascinating example of the success of a business truly benefiting the customer, and in turn, the community as a whole. DJ Khaled would be proud.… In fact, ALL they do is WIN-WIN-WIN.