Effective care coordination and transition planning are essential to delivering higher quality care and achieving better outcomes while reducing the total cost of care. This is especially true in the management of complex, long-term conditions like chronic kidney disease and end-stage renal disease. In this White Paper, we discuss current best practices in care coordination and how these practices can be implemented. We also provide an overview of how our Kidney Population Health Management program is designed to break down siloed care and support provider communication and collaboration.