ESRD Seamless Care Organizations: Debuting Soon

Nearly two years after the Centers for Medicare and Medicaid Innovation (CMMI) announced the first-ever disease-specific innovation model, the first performance period of the ESRD Seamless Care Organizations (ESCO) program is slated to begin in January 2015. Large Dialysis Organization (LDO)-based ESCOs will be the first to participate in the program, followed by ESCOs operated by Small Dialysis Organizations (SDOs) in July 2015. Speaking at a meeting of the Council of Medical Subspecialty Societies in late November 2014, CMMI Seamless Care Models Group Director Hoangmai Phan, MD, confirmed the early 2015 launch date.

But as 2014 wound to a close, unanswered questions about the program remained—even after two major CMMI overhauls to the design and operation of the program as well as several delays in the program start date. As of press time, CMMI had not yet finalized the quality measures upon which the dialysis providers and nephrology practices that join together will be judged. CMMI engaged a contractor to convene a technical expert panel (TEP) to select quality measures, but to date contractor IMPAQ states that “CMS is conducting further research on the feasibility, usability, and technical considerations of the following proposed draft measurement set” TEP developed.

Because CMMI has been adamant that the ESCO program goes beyond kidney care to providing comprehensive care, it is highly likely that quality measures will expand beyond familiar quality improvement metrics. However, it remains to be seen whether the measures selected will have been tested and verified in the ESRD patient population—and whether the performance criteria will reflect the unique ESRD patient population.

The Innovation Center has been tight-lipped regarding how many applications it received for the ESCO program, but rumors suggest that approximately 15 LDO ESCO applications were submitted. CMMI convened two reviewer panels to assess applications, one in July for LDO ESCOs and one in September for SDO ESCOs, but it has not released any public information about the panels or next steps for the applicants. Of course, CMMI approval of an application does not bind the applicants to launching an ESCO, so these numbers may not accurately reflect the program’s chances of success. Much will depend on how CMMI decides on some of the program’s yet-unanswered questions.

The year 2015 will be the proving ground for this new program, which will likely also set the tone for future disease-specific innovation models.