What is the Value Based Care Model for kidney patients?
January 7, 2022
East Bay Nephrology Medical Group participates in Medicare Value Based Care,Kidney Care Choices model, in affiliation with Integrated Kidney Care of Northern California.
WHAT IS THE KCC Model?
Kidney Care Choices (KCC) modelwhich builds upon the existing Comprehensive End-Stage Renal Disease Care (CEC) Model was announced by the Centers for Medicare & Medicaid Services (CMS) in October 2019. The KCC Model adds strong financial incentives for health care providers, nephrologists, transplant providers, and possibly dialysis providers, to manage the care of Medicare beneficiaries withchronic kidney disease (CKD) stages 4 and 5 and end-stage renal disease (ESRD), to delay dialysis initiation and increase kidney transplantation. This 5-year program will test new payment models to bring in value, to improve quality care and clinical outcomes, and decrease overall cost of care for people with Medicare living with CKD and ESRD.
According to theUS Renal Data System (USRDS), at the end of 2019, people living with ESRD constituted 1% of the Medicare population and accounted for an estimated 7.2% of Medicare spending, totaling over $51 billion. At the same time, total spending for beneficiaries with CKD who did not have ESRD was $87.2 Billion. Per person per year (PPPY) costs were 40% higher for CKD 4 and 5 than stage 3 CKD. Based on USRDS, in 2019, 85% of those with incident ESRD initiated in-center hemodialysis as opposed to other modalities. This represents a decrease from 91% in 2009. Over the past decade, the percentage initiating kidney replacement therapy with peritoneal dialysis nearly doubled, from 6% to 11%. The percentage who received a preemptive kidney transplant remained unchanged over the decade at about 3%. There are more than 490,000 People with ESRD who spend an average of 12 hours a week receiving in-center hemodialysis. In addition, there are more than 1.1 million people with late-stage CKD 4 and 5. KCC isdesigned to help health care providers reduce the cost and improve the quality of care for these patients. This Model also aims to delay the need for dialysis and encourage kidney transplantation.
These high costs of care mentioned above are often the result of complications of the underlying disease and multiple co-existing diseases, which often lead to more hospital admission and readmissions, as well as a higher mortality rate that is higher than the general Medicare population and poorer health outcomes. Beneficiaries often end up requiring multiple visits to multiple providers, which results in multiple care plans, making it challenging for the patient if their care is not coordinated. Through enhanced care coordination by the Integrated Kidney Care of Northern California, these individuals will have a more patient-centered care experience, which is ultimately expected to improve quality and health outcomes.
The KCC Model’s first Performance Year start date will be January 1, 2022, and it is designed to operate for 5 years.
WHAT IS THE CKCC MODEL?
CKCC is the Comprehensive Kidney Care Contractingoption announced by CMS as a voluntary kidney care payment option, in which capitated payments are paid for managing care of aligned beneficiaries with CKD Stages 4 or 5, and for those on dialysis adjusted based on health outcomes and utilization. TheKidney Contracting Entities (KCE)– which consist of nephrologists, transplant providers, and other health care providers including dialysis facilities – will take responsibility for the total cost and quality of care for their patients, and in exchange, can receive a portion of the Medicare savings they achieve.
HOW DOES THIS HELP PATIENTS?
The principal goal of the model is to delay initiation of dialysis, slow the progression of kidney disease and promote kidney transplantation. People living with late-stage CKD and ESRD will have an improved care experience. The patient is a key component of the Model design. The tendency now is for patients with kidney disease to follow the most expensive path, with little prevention of disease progression and an unplanned start to in-center hemodialysis treatment. By increasing education and understanding of the kidney disease process, aligned beneficiaries may be better prepared to actively participate in shared decision making for their care. To that end, East Bay Nephrology will enhance the initiatives it has worked on for many years.
To safeguard Medicare beneficiaries, CMS has developed a model that puts people with Medicare at the focal point of their care:
Putting People First
The model creates aligned incentives for providers to work as a team to improve the health care received by people with late-stage CKD and ESRD.
Beneficiaries Freedom of Choice
People with Medicare matched to a KCE not only maintain all the rights and benefits of beneficiaries in Medicare fee-for-service including the freedom to see any health care provider that accepts Medicare, but also get enhanced benefits like kidney disease education, telehealth, as well as concurrent care for beneficiaries that elect hospice benefits.
CMS will routinely monitor and analyze claims data assessing the utilization of services by beneficiaries. This monitoring will occur using chart audits, interviews and periodic site visits conducted by or on behalf of CMS to facilitate evaluation, shared learning activities, or the fulfilment of the terms of the Contract Agreement
CMS also believes it is important that beneficiaries and their advocates be meaningful partners in improving care delivery. The governing body of each KCE must include at least one beneficiary representative or independent consumer advocate. Through this representation, CMS will ensure that the beneficiary and consumer representatives participate in all strategic decisions made by the organizations and that the beneficiary perspective is integrated into operations.
HOW IS THIS PAYMENT MODEL DIFFERENT?
Under the Comprehensive Kidney Care Contracting model, participating organizations will be held financially accountable for delivering high quality care and improving the health outcomes of their aligned beneficiaries. Participating KCEs will be required to report on a variety of care delivery and health outcome measures across the continuum of care, not only those related to ESRD services. KCEs in CKCC Professional option will have an opportunity to earn 50% of shared savings or be liable for 50% of shared losses based on the total cost of care for Part A and B services.
KCEs can earn back portion of 5% holdback from the benchmark based on their quality scores achieved by providing a high standard of quality. CMS will hold entities liable for portions of any losses or increased cost of care.
East Bay Nephrology Medical Group participation in Kidney Care Choices (KCC) doesn't limit patient’s choice. Medicare benefits are not changing. Patients have access to the same care. Patients still have the right to visit any doctor, hospital, or other provider that accepts Medicare at any time, just like they do now.
For Frequently asked questions, please refer to the summary prepared here.
For more information on the KCC Initiative, please visit the Centers for Medicare & Medicaid Services website at: