After a long period of consultation with ASN and others in the kidney community, Department of Health and Human Services (HHS) Secretary Alex M. Azar, II, yesterday unveiled the four voluntary kidney care payment options of the Kidney Care Choices ( KCC ) Model that are a part of the Advancing American Kidney Health (AAKH) initiative. ASN President Mark E. Rosenberg, MD, FASN, calls the AAKH initiative “a true game changer.”

ASN worked closely with HHS providing input and recommendations on overall initiative and the proposed ESRD Treatment Choices (ETC) Model.  The KCC Model is designed to complement the ETC Model, which ASN supports with the incorporation of recommended improvements, and would aim to delay the need for dialysis and promote kidney transplantation. The four voluntary options of the KCC include the Kidney Care First (KCF) Option and three Comprehensive Kidney Care Contracting (CKCC) Options – the graduated, professional, and global CKCC Opinions.

The KCC Model has a strong focus on slowing the progression of kidney disease before a person reaches kidney failure and incentivizes more kidney transplantation.  KCC’s goals include:

• Later and better starts on dialysis for Medicare patients with kidney disease
• Better coordination of care for these individuals with kidney disease and kidney failure to reduce total cost of care
• More individuals receiving kidney transplants and staying off dialysis for longer
• Different financial risk options for nephrologists and other providers and suppliers to take on financial accountability
   

Medicare says the model builds upon the existing Comprehensive 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.

Patients who qualify for the KCC Model and its four options must be:

• Medicare beneficiaries with CKD stages 4 and 5;
• Medicare beneficiaries with ESRD receiving maintenance dialysis; or
• Medicare beneficiaries who were aligned to a KCF practice or kidney contracting entities (KCE) by virtue of having CKD stage 4 or 5 or ESRD and then later received a kidney transplant.
   

For the Kidney Care First (KCF) Option, nephrologists and nephrology practices will receive adjusted capitated payments for managing Medicare beneficiaries with CKD stages 4 and 5 and ESRD, and they will be eligible for upward or downward payment adjustments based on the quality of their performance and improvements in their performance over time. The KCF Option will include Benefit Enhancements to enable nephrologists to strengthen care coordination for beneficiaries with CKD stages 4 and 5, as well as new financial mechanisms to enable participants to manage cash flow. The KCF Option will be a Merit-based Incentive Payment System (MIPS) Alternative Payment Model APM in 2020 and an Advanced Alternative Payment Model (Advanced APM) beginning in 2021.

For the CKCC Options, nephrologists and nephrology practices must partner with transplant providers, and may partner with dialysis facilities and other providers and suppliers to become Kidney Contracting Entities (KCEs). KCE nephrologists will receive adjusted capitated payments for managing Medicare beneficiaries with CKD stages 4 and 5 and kidney failure.

The payments will be adjusted based on health outcomes and utilization of resources compared to the participating practice’s own experience and national standards, as well as performance on quality measures. In addition, participating practices will receive a bonus payment for every patient aligned to them that receives a kidney transplant based on the transplant remaining healthy for up to three years.

Transplant bonus:

• $2,500 for year one
• $5,000 for year two
• $7,500 for year three
   

The Medicare team responsible for drafting the KCC Model will participate in a Forum on the Executive Order on Advancing American Kidney Health, Particularly the Kidney Care Delivery Models at Kidney Week to discuss the voluntary payment models on Thursday, November 7, from 10:30 am – 12:30 pm ET in room 206.  The team will also be answering questions at the Communities Booth in the Exhibitors Hall that same day from 1:30-2:30 pm ET.