Kidney Care Choices (KCC) Model

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.

Background

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:

  • CMS Kidney Care First (KCF) Option
  • Comprehensive Kidney Care Contracting (CKCC) Graduated Option
  • Comprehensive Kidney Care Contracting (CKCC) Professional Option
  • Comprehensive Kidney Care Contracting (CKCC) Global Option

Model's Details

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:

  • Medicare beneficiaries with CKD stages 4 and 5.
  • Medicare beneficiaries with ESRD receiving maintenance dialysis.
  • Medicare beneficiaries who were aligned to a KCF practice or KCE by virtue of having CKD Stage 4 or 5 or ESRD and receiving dialysis that then receive a kidney transplant.

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.

CMS Kidney Care First (KCF) Option

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.

Comprehensive Kidney Care Contracting (CKCC) - Graduated, Professional and Global Options

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:

  • CKCC Graduated Option: This payment arrangement is based on the existing CEC Model One-Sided Risk Track – allowing certain participants to begin under a lower-reward one-sided model and incrementally phase in to greater risk and greater potential reward.
  • CKCC Professional Option: This payment arrangement is based on the Professional option of the Global and Professional Direct Contracting Model – with an opportunity to earn 50% of shared savings or be liable for 50% of shared losses based on  the total cost of care for Part A and B services.
  • CKCC Global Option: This payment arrangement is based on the Global option of the Global and Professional Direct Contracting Model – with risk for 100% of the total cost of care for all Parts A and B services for aligned beneficiaries.

Timelines

The KCC Model Performance Period began on January 1, 2022, and will continue through December 31, 2026.  CMS solicited applications for the first cohort of KCC Model participants in October 2019. Healthcare providers interested in participating applied by January 22, 2020. Applicants selected for participation began an Implementation Period in late 2020, to focus on building necessary care relationships and infrastructure. The Implementation Period extended through 2021 to enable model participants to prepare to take on financial and population health accountability starting in January 2022. The first cohort of KCC Model participants began their participation in the Model performance period on January 1, 2022. CMS is now soliciting applications for a second cohort of KCC Model participants.

CMS invites interested applicants to submit their applications to CMS by March 25, 2022. If selected to participate in the Model, the second cohort of KCC Model participants would begin Model participation on January 1, 2023, after executing performance period participation agreements that will set forth the terms of the KCF Option or the CKCC Options of the KCC Model, as applicable. The performance period participation agreements for these KCC Model participants will have a term of four Performance Years (PYs) (2023, 2024, 2025, and 2026). CMS does not plan to conduct any further solicitations for KCC Model participants.

Information for Interested Stakeholders

If you are interested in receiving CMS Innovation Center updates, including about the KCC Model, subscribe to the CMS Innovation Center listserv.

If you are interested in receiving additional information and updates specifically about the KCC Model, please subscribe to the KCC listserv.

For any questions, please email the KCC model team at KCF-CKCC-CMMI@cms.hhs.gov.

Provider Resources

Under the direction of CMS, the ESRD Network Program consists of a national network of 18 ESRD Networks, responsible for each U.S. state, territory, and the District of Columbia. ESRD Networks service geographic areas based on the number and concentration of ESRD beneficiaries.

KCC Entities

Webinars

Additional Information

Financial Methodology

Additional Research 

Last updated on:
11/09/2022