Health Equity in Kidney Care

Lorien Dalrymple, MD, MPH is an experienced nephrologist focused on improving the quality of healthcare. In January 2024 she was promoted to Senior Vice President and Head of Population Health and Medicine at Fresenius Medical Care, where she is leading work related to measuring healthcare quality and reducing health disparities. We asked her to share her background and perspective on how Fresenius Medical Care can help reduce health disparities and advance health equity.

Q: Tell us a little bit about yourself and what drew you to nephrology as a specialty.

A: I attended medical school at the University of Colorado and then completed my internal medicine residency and nephrology fellowship training at the University of Washington. At these institutions I had the opportunity to learn from exceptional nephrologists. I chose nephrology as a subspecialty because of the opportunity to have long-term care relationships with patients and their families, the need for complex medical decision-making, and interesting pathophysiology. While I was at the University of Washington, I also completed my Master of Public Health degree.

I have had a longstanding interest in the measurement of healthcare quality. I was on the National Quality Forum Renal Standing Committee and had the opportunity to serve as a committee co-chair.

Q: What factors did you consider when you joined Fresenius Medical Care?

A: It was, and still is, the opportunity to influence and improve care for people with kidney disease. The potential scale of impact is unique to large healthcare providers.

Q: Can you give us a brief overview of your time with Fresenius Medical Care so far?

A: I joined the company in 2016 as Vice President for Epidemiology and Research in the Fresenius Medical Care North America Medical Office. In 2020, I was appointed to Global Head of Population Health. My roles and responsibilities continued to evolve until my promotion to Senior Vice President and Head of Population Health and Medicine for the Global Medical Office in January 2024.

While my roles and responsibilities have evolved over the years, I have always provided clinical and epidemiologic expertise within the organization. My current responsibilities include further development of global healthcare quality and safety measures, collaboration across the organization to develop and implement a global health equity strategy, collaboration with U.S. academic institutions on research, and support of organizational sustainability efforts.

Q: Why is health equity important in kidney care globally?

A: Health equity and reducing health disparities is important across all healthcare fields and settings. It's well recognized throughout the world that health disparities exist, and there are many factors that lead to these observed differences. The question we should be asking ourselves at Fresenius Medical Care is, how do we as a healthcare organization meaningfully address and reduce known health and healthcare disparities? Healthcare organizations have an important and critical role in reducing health disparities and advancing health equity.

As an example, in the U.S. there has been a focus on increasing the overall use of home dialysis, yet disparities have not been adequately addressed and much more work is needed to reduce differences in the use of home dialysis based on socioeconomic status or race and ethnicity.

Q: What improvements is Fresenius Medical Care working toward in the health equity space — in the U.S. and globally? What are your immediate priorities?

A: First, let me describe some of the work in the U.S. We're creating the U.S. Health Equity Strategic Plan, which will be adopted by every facility in the U.S. We will use our demographic and clinical data to identify and address disparities and make those insights available at the clinic level, not just at a regional or national level. Later this year, clinics in the U.S. will be able to use clinic-level data to identify disparities in their population under care and use this information to improve the quality of care.

One of the initiatives I'm most excited about is our plan to launch a national quality improvement project focused on lowering food insecurity in our end stage kidney disease population under care in the U.S. This will be a multiyear effort where we'll be disciplined in screening and developing interventions to lower food insecurity. These activities are foundational to fulfilling the End Stage Renal Disease Quality Incentive Program Facility Commitment to Health Equity.

In the rest of the world, we will first focus on creating a global steering committee responsible for the governance of FME [Fresenius Medical Care] global health equity initiatives and a global data framework for identifications of health disparities.

Q: How do you envision continuing to promote health equity in your new role?

A: Fresenius Medical Care, as a healthcare organization, wants everyone to have the highest level of health and well-being possible. Healthcare organizations need to focus on and be committed to addressing health disparities. Reducing health disparities is integral to providing high-quality healthcare. I am focused on collaborating across the organization to drive progress towards the reduction of health disparities and advancement of health equity.