Learn how the Chronic Kidney Care Contracting (CKCC) model helps improve the quality of care for patients with chronic kidney disease (CKD)
The Centers for Medicare & Medicaid Services (CMS) has developed the Chronic Kidney Care Contracting (CKCC) model to improve the quality of care for patients with chronic kidney disease (CKD). The model is designed to improve the coordination of care among patients, providers, and payers, while also reducing costs associated with the treatment of CKD. The CKCC model is based on the belief that when care is actively coordinated and managed, patients with CKD can receive better health outcomes and lower costs.
CKD is a progressive condition that is estimated to affect more than 30 million Americans. As CKD progresses, patients are at higher risk of developing end-stage renal disease, which can require dialysis treatment or a kidney transplant. Treatment for CKD is complex and can be costly, and is often managed by multiple providers, including primary care physicians, nephrologists, and other specialists. As a result, it can be difficult for patients to receive the care they need in a timely and coordinated manner.
The CKCC model is designed to address these challenges and improve care coordination, while also reducing costs associated with CKD. The model focuses on four core components: 1) care management, 2) patient education, 3) cost savings, and 4) quality improvement. The model is intended to be implemented by Medicare Advantage (MA) plans, which are private health plans that contract with the CMS to provide health care coverage to Medicare beneficiaries.
The CKCC model focuses on care management, which involves coordinating care among providers and other stakeholders to ensure that patients receive the care they need in a timely and efficient manner. Care management involves creating a comprehensive plan of care for each patient based on their individual needs, which includes identifying and addressing any gaps in care. The plan of care is then shared among providers to ensure that all stakeholders have access to the same information and can coordinate care accordingly.
The CKCC model also focuses on patient education, which is designed to help patients better understand their condition and how to manage it. This includes providing patients with information about their medications, lifestyle modifications, and other forms of self-management. The goal of patient education is to empower patients to take an active role in managing their health and to help them make informed decisions about their care.
The CKCC model is also designed to reduce costs associated with CKD. This is accomplished through a variety of strategies, including increasing the use of generic medications, reducing emergency department visits, and improving medication adherence. Additionally, the model encourages the use of telehealth technologies and remote patient monitoring to increase access to care and reduce the need for in-person visits.
Finally, the CKCC model focuses on quality improvement, which involves measuring and tracking outcomes to ensure that patients are receiving the best possible care. The model uses a variety of measures, including patient satisfaction surveys, clinical quality measures, and cost measures, to evaluate and improve the quality of care.
Kidney Care Choices (KCC) builds upon the existing Comprehensive End Stage Renal Disease (ESRD) Care (CEC) Model structure – in which dialysis facilities, nephrologists, and other health care providers form ESRD-focused accountable care organizations to manage care for beneficiaries with ESRD – by adding strong financial incentives for health care providers to manage the care for Medicare beneficiaries with chronic kidney disease (CKD) stages 4 and 5 and ESRD, to delay the onset of dialysis and to incentivize kidney transplantation. The model will have four payment Options: CMS Kidney Care First (KCF) Option, Comprehensive Kidney Care Contracting (CKCC) Graduated Option, CKCC Professional Option, and CKCC Global Option.
The current Medicare payment system encourages in-center hemodialysis as the default treatment for patients beginning dialysis. According to the Government Accountability Office, in-center hemodialysis is the most common type of dialysis and was used by about 88 percent of dialysis patients in 2016. There are more than 430,000 Medicare Fee-for-Service beneficiaries with ESRD who spend an average of 12 hours a week receiving in-center hemodialysis. Many beneficiaries with ESRD suffer from poorer health outcomes, such as higher hospitalization and mortality rates, often the result of underlying disease complications and multiple co-morbidities.
The KCC Model is designed to help health care providers reduce the cost and improve the quality of care for patients with late-stage chronic kidney disease and ESRD. This Model also aims to delay the need for dialysis and encourage kidney transplantation.
The KCC Model includes four Options:
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.
Beneficiaries who meet the following criteria will be eligible to be aligned to this Model:
Alignment takes into consideration where a beneficiary receives the majority of their kidney care. When an aligned beneficiary receives a kidney transplant, they will remain aligned to the model participant for three years following a successful kidney transplant or until the time a kidney transplant fails, at which point the beneficiary could be re-aligned if they meet the requirements for alignment by virtue of their ESRD.
The KCF Option is open to participation by nephrology practices and their nephrologists and nephrology professionals only, subject to meeting certain eligibility requirements.
Participating nephrologists, nephrology professionals, and nephrology practices receive adjusted capitation payments for managing care of aligned beneficiaries with CKD Stage 4 or 5, and for those on dialysis. These payments are adjusted on the basis of health outcomes and utilization compared to both the participants’ own experience and national standards, and also performance on quality measures. In addition, KCF Practices will receive a bonus payment for every aligned beneficiary who receives a kidney transplant, with the full amount of the bonus paid over three years following the transplant provided the transplant remains successful.
The CKCC Options are open to participation by Kidney Contracting Entities (KCEs). KCEs are required to include nephrologists or nephrology practices and transplant providers, while dialysis facilities and other providers and suppliers are optional participants in KCEs.
In the CKCC Graduated, Professional, and Global Options, KCEs receive capitation payments that are similar to the capitation payments under the KCF Option. KCEs take responsibility for the total cost and quality of care for their patients, and in exchange, can receive a portion or all of the Medicare savings they achieve.
The three CKCC Options will have distinct accountability frameworks:
The CKCC model is an innovative approach to improving the quality of care for patients with CKD. The model focuses on care management, patient education, cost savings, and quality improvement in order to ensure that patients receive the best possible care and that costs associated with CKD are reduced. The model is currently being implemented by Medicare Advantage plans and is expected to provide significant benefits to both patients and providers.