Comprehensive ESRD Care Model

The Comprehensive ESRD Care (CEC) Model is designed to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease (ESRD). Through the CEC Model, CMS will partner with health care providers and suppliers to test the effectiveness of a new payment and service delivery model in providing beneficiaries with person-centered, high-quality care. The Model builds on Accountable Care Organization experience from the Pioneer ACO Model, Next Generation ACO Model, and the Medicare Shared Savings Program to test Accountable Care Organizations for ESRD beneficiaries.

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There are 37 ESRD Seamless Care Organizations (ESCOs) participating in the Comprehensive ESRD Care Model. (List


Background

More than 600,000 Americans have ESRD and require life sustaining dialysis treatments several times per week. Many beneficiaries with ESRD suffer from poorer health outcomes, often the result of underlying disease complications and multiple co-morbidities. These can lead to high rates of hospital admission and readmissions, as well as a mortality rate that is higher than that of the general Medicare population. 

According to the United States Renal Data System, in 2014 ESRD beneficiaries comprised less than 1% of the Medicare population, but accounted for an estimated 7.2% of total Medicare fee-for-service spending, totaling over $32.8 billion. Because of their complex health needs, beneficiaries often require visits to multiple providers and follow multiple care plans, all of which can be challenging for beneficiaries if care is not coordinated. The CEC Model seeks to create incentives to enhance care coordination and to create a person-centered, coordinated, care experience, and to ultimately improve health outcomes for this population.

Model Details

In the CEC Model, dialysis clinics, nephrologists and other providers join together to create an ESCO to coordinate care for matched beneficiaries. ESCOs are accountable for clinical quality outcomes and financial outcomes measured by Medicare Part A and B spending, including all spending on dialysis services for their aligned ESRD beneficiaries. This model encourages dialysis providers to think beyond their traditional roles in care delivery and supports them as they provide patient-centered care that will address beneficiaries’ health needs, both in and outside of the dialysis clinic.

The CEC Model includes separate financial arrangements for larger and smaller dialysis organizations. Large Dialysis Organizations (LDOs), which have 200 or more dialysis facilities, will be eligible to receive shared savings payments. These large dialysis organizations will also be liable for shared losses, and will have higher overall levels of risk compared with their smaller counterparts.

Non-large dialysis organizations (Non-LDOs) which includes chains with fewer than 200 dialysis facilities, independent dialysis facilities, and hospital-based dialysis facilities. Non-LDOs will have the option of participating in a one-sided track where they will be able to receive shared savings payments, but will not be liable for payment of shared losses, or participating in a track with higher risk and the potential for shared losses. The one-sided track is offered in recognition of non-LDOs more limited resources.

Quality and financial results are provided for Performance Year 1 (2016):

Performance Year 1 (2016) (PDF)

The CEC Model began September 1, 2015 and will run until December 31, 2020. The CEC Model conducted a solicitation in 2016 to add more ESCOs for PY 2 of the model to start January 1, 2017. The Model has no current plans for another round of solicitation.

The CEC Model LDO payment track and Non-LDO two-sided payment track are considered Advanced APMs for the purpose of the Quality Payment Program.  For more information, please visit the Quality Payment Program website.

Additional Information

Questions about the Comprehensive ESRD Care initiative application, or the initiative generally, can be sent to ESRD-CMMI@cms.hhs.gov.