3 Ways to Succeed in the

CMS Kidney Care Choices Model 

In recent years, CMS has made significant efforts to improve quality of care for beneficiaries with Chronic Kidney Disease (CKD) and End-stage Renal Disease (ESRD) while reducing costs. These efforts include the mandatory ESRD Treatment Choices (ETC) Model, as well as a voluntary value-based care model – Kidney Care Choices (KCC). Kidney Care Choices builds upon the existing Comprehensive End Stage Renal Disease Care Model structure and empowers nephrologists to coordinate patient care in order to promote increased care coordination, ensure later and better starts on dialysis, and increase the number of successful kidney transplants.

There are two program options within KCC: Kidney Care First and Comprehensive Kidney Care Contracting. The Implementation Period for each program began in 2020 and participants for each program will assume financial accountability beginning January, 2022. Below is an overview of each program and their payment structures.

Kidney Care First (KCF) – KCF is designed for nephrology practices and those new to value-based care. Participants are paid per beneficiary capitations for CKD and ESRD patients, which are then adjusted up to +30% or down to -20% based on the participant’s quality & utilization measure scores.

Comprehensive Kidney Care Contracting (CKCC) – CKCC is designed for nephrology practices partnering with transplant and other kidney care providers. Participants are paid the same capitations for CKD and ESRD patients, and select one of three risk tracks, each representing a different level of total cost of care risk. Risk track options include: 

      • Upside-only risk with a lower reward (Graduated)
      • 50/50 shared savings and losses (Professional)
      • 100% total cost of care risk (Global)

Despite the different payment structures, the two programs are aligned in factors that will determine a participant’s success, whether it be in maximizing the performance-based adjustment (PBA) in KCF or increasing savings in CKCC. 

3 Ways to Succeed in the KCC Program:

In order to be successful in either KCC program, providers caring for CKD and ESRD patients need to have proper tools, resources, and data to reduce the total cost of care, adhere to quality measures, and engage patients post-discharge. 

1. Reduce Acute Hospitalization Utilization and the Total Cost of Care

One of the most important components of financial success for both the KCF and CKCC programs is the participant’s ability to reduce hospitalizations and total cost of care (aka “total per capita cost”). This can be done by preventing avoidable readmissions and preventing unnecessary emergency department (ED) utilization. In the KCF program, doing so will drive a greater performance-based adjustment and in the CKCC program, the same actions will result in greater savings versus the benchmark. 

So how do participants actually impact these components of care? The first step is knowing in real-time when beneficiaries are discharged from the hospital or admitted to a post-acute facility. From there, KCC program participants can reach out to the patient or facility to ensure the appropriate post-discharge care is delivered, educate the patient on resources and appropriate ED utilization, or work with the admitting facility to ensure appropriate LOS. 

2. Ensure Top Performance in Quality Measures

In addition to reducing costs, participants in KCF & CKCC models will need to provide high-quality care by engaging beneficiaries over time, especially after an acute event, in order to maximize performance adjustments and earn back quality withholds. Four National Quality Forum (NQF) quality measures indicate such necessities:  

  1. Patient Activation Scores
  2. Depression Remission
  3. Managing High Blood Pressure
  4. Optimal ESRD Starts

These measures are all components of care that are managed and improved over time, but KCC participants have a meaningful opportunity to make strides in closing quality gaps after an acute event, when a patient may be seeking care or open to behavior changes. For example, a patient recently discharged from the hospital may benefit from a follow-up visit with their provider. During that visit, a clinician can address the patient’s blood pressure, discuss their mental health status, and educate the patient on managing their physical health – all of which support key quality measures in KCC programs and help participants succeed within the model. 

3. Minimize Leakage Rates

By identifying beneficiary utilization outside of their practice as well as engaging the patient with appropriate care in their practice, KCC participants can minimize outmigration (or “leakage”) rates. In fact, both the KCF and CKCC models include payment adjustments for leakage rate, which they define as the amount of nephrology services beneficiaries receive outside of the participant’s organization. Therefore, KCC participants will receive reduced capitation payments if they experience outmigration.

To counteract this, KCC participants should aim for high beneficiary retention rates by engaging beneficiaries at key touch points throughout their care journey, such as directly after an acute care event. Acute care events can present an opportunity to engage beneficiaries and ensure they are receiving the care they need within the participant’s practice. 

KCC participants can improve performance in all three aforementioned ways by leveraging real-time admission, discharge, and transfer (ADT) data for their beneficiaries. Actionable ADT data can drive targeted interventions to support reduction in Acute Hospital Utilization and Total Per Capita Cost, as well as support quality performance improvement and beneficiary retention. 

PatientPing supports provider success in Kidney Care Choices and other value-based kidney care models by optimizing encounter efficiency, reducing avoidable utilization, and ensuring patients are receiving critical care when they need it. PatientPing is powered by the nation’s largest network of ADT data from over 1,100 hospitals and over 6,000 post-acute facilities.

For more information on how to prepare and succeed under Kidney Care Choices or to learn more about PatientPing, contact us at [email protected] or complete our contact form.