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Reaching for better quality patient care

Reaching for better quality patient care

Session: Hot Off the Press: The Advancing American Kidney Health Initiative and More

Sub-Session: Deep Dive on New Kidney Care Delivery Models

Presenter: Tom Duvall, Acting Division Director for the Division of Special Populations and Projects at the Center for Medicare and Medicaid Innovation

Tom DuvallEven on the final day of Kidney Week 2019, the remaining attendees’ energy level and riveted interest remained high — particularly in the morning session devoted to late-breaking developments in public policy.  Case in point, the sub-session on new kidney care delivery models, present by Tom Duvall, Acting Division Director for the Division of Special Populations and Projects at the Center for Medicare and Medicaid Innovation (CMMI), which contains the CEC Model, the KCC Model, and the ETC Model.

Duvall began by honoring the CEC’s model’s foundation. “The positive results we saw from CEC helped create new efforts. For example, with the CEC Model we saw about a 2 percent reduction in cost, a 4 percent reduction in hospitalizations, an 8 percent reduction in catheter rates, and a decrease in mortality. But there were also areas where we hoped for potential changes that didn’t happen. There was no real change in home dialysis, transplant rates, and nothing going upstream to slow down the progression of the disease. And there were no specific incentives built into those areas. So, we built on what we learned through CEC and created a much bigger focus beneficiaries’ care needs.”

That’s how the Comprehensive ESRD Care (CEC) Model evolved into the Kidney Care Choices (KCC) Model. 

The KCC Model will debut in 2020 and will run through 2023, with the option for CMMI to extend the Model for one or two additional years. The KCC Model begins with the single set of providers and suppliers responsible for a patient’s care from CKD stages 4 and 5, through dialysis, and continuing through transplant, or end of life care.

“Based on CEC feedback and years of discussions, we created KCC, which focuses on the full spectrum of care,” Duvall explained. In a nutshell, the KCC Model will improve on CEC with distinct goals, including:

  • Later and better starts on dialysis for beneficiaries with CKD.
  • Better coordination of care for beneficiaries with CKD and ESRD to reduce total cost of care.
  • More beneficiaries receiving kidney transplants and staying off of dialysis longer.
  • Offering different financial risk options for nephrologists and other providers and suppliers to take on financial accountability.

 In addition, KCC encompass:

  • Beneficiaries across the full spectrum of kidney disease, including CKD Stages 4 and 5 and ESRD, as well as beneficiaries who receive kidney transplants.
  • Nephrologist payment reforms.
  • Additional Medicare benefit enhancements.

KCC is about four payment options with two different tracks. “Both tracks are based around the idea of long-term care coordination across the full spectrum of care, with some entity taking on that accountability,” Duval said.

Here’s a quick breakdown of the four payment options and who can participate

Kidney Care First (KCF) Model: This is based on the Primary Care First (PCF) Model, with nephrology practices eligible to receive bonus payments for effective management of beneficiaries. Participants include nephrologist and nephrology practices only.

CKCC Graduated Option: This is based on the existing CEC Model One-Sided Risk Track, which allows certain participants to begin under a lower-reward, one-sided model and incrementally phase in risk and additional potential reward.

CKCC Professional Model: This is based on the Professional Population-Based Payment option of the Direct Contracting Model, with 50 percent of shared savings or shared losses in the total cost of care for Part A and Part B services.

CKCC Global Model: This is based on the Global Population-Based Payment option of the Direct Contracting Model, with risk for 100 percent of the total cost of care for all Part A and Part B services for aligned beneficiaries.

Participants for all CKCC payment options must include nephrologists and nephrology practices. In addition, participants may include transplant providers, dialysis facilities, and other kidney care providers on an optional basis.

“There are different reasons why we encourage people to participate in KCC,” Duvall said. “Reason number one is the opportunity to improve quality of care. To achieve this goal, we constructed a financial model that incentivizes that goal. We think we hit it.”

The five key payment mechanisms include:

  1. Adjusted Monthly Capitated Payment (AMCP): Capitated payment paid to model participants to managed ESRD, based on the MCP.
  2. CKD Quarterly Capitated Payment (CKD QCP): Capitated payment paid to model participants to manage CKD 4/5 patients.
  3. Kidney Transplant Bonus (KTB): Incremental reimbursement for successful kidney transplant.
  4. Shared Savings/Losses: Based on total cost of care compared to benchmark (available to CKCC option participants only).
  5. Performance Based Adjustment (PBA): Upward or downward adjustment to the CKD QCP and AMCP based on participants year-over-year continuous improvement and performance relative to peers (available to KCF practices only).

“We’ve heard proposals for years — about how we should do coordinated kidney care and how we should build on CEC,” Duvall said. “This is what everybody’s been waiting for here. And this is why we encourage folks to participate.”

Before leaving the speaker’s podium, Duvall added one pitch. “We’re here to work with you. We want to hear what you have to say. And the best way to do this is to apply and join us.” 

If interested in participating in the KCC Model, applications must be submitted by January 22, 2020. To find out more about the KCC Model, visit: https://innovation.cms.gov/initiatives/kidney-care-choices-kcc-model.

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