Accountable Care Organizations and Nephrology-Specific Care Remain Key Issues for 2013


With the successful launch of several Accountable Care Organization (ACO) programs—including the Pioneer ACO model, the Advance Payment model, and the Medicare Shared Savings Program—the Center for Medicare and Medicaid Innovation (CMMI) is looking toward implementing similar strategies to coordinate care and improve outcomes for groups of patients with specific diseases. All signs suggest that the Centers for Medicare & Medicaid Service’s Innovation Center is interested in launching a nephrology-specific integrated nephrology care delivery model pilot project or demonstration—which would make it the first-ever disease-specific integrated care delivery model.

Once again, the nephrology community is poised to pioneer innovations in patient care delivery and payment ahead of other areas of medicine.

Here’s what to watch as the year progresses:

The Innovation Center’s announcement of a request for proposals to participate in a pilot project or demonstration. Although there was some speculation that an RFP would be released in the fall of 2012, and later that it might be released following the presidential election, as of press time no announcement had been made. Details on the scope of pilot or demonstration projects—and whether there might be multiple models. Multiple models could help facilitate the participation of a diverse range of provider types and locations as well as enable patients in different care environments to benefit. ASN and other patient and health professional organizations have also advocated that at least one pilot or demonstration project should include “upstream” patients with late-stage chronic kidney disease (CKD) in addition to patients with end stage renal disease (ESRD). Also unknown is how “prescriptive” an RFP might be; would CMMI specifically delineate the components it wants to see in a pilot or demo, or will applicants be encouraged to innovate independently, proposing a diversity of care delivery strategies?


How many entities respond to the RFP and, ultimately, how many patients have the opportunity to receive care in these cutting-edge new care delivery pilots or demos.

Regardless of what a final pilot or demonstration project will look like, there is considerable excitement within the nephrology community as well as within the Innovation Center that a nephrology-specific integrated nephrology care delivery model could foster transformative improvements in patient care and produce valuable lessons for other areas of medicine—such as oncology—that may look to develop integrated care delivery models in the future.

January 2013 (Vol. 5, Number 1)