Future of CKD Care Remains Focused on Value, Even With CMMI Delay

Earlier this month, the new head of the Center for Medicare and Medicaid Innovation (CMMI) within CMS discussed how it is reassessing its various alternative payment models, including ones related to kidney care.

While acknowledging that the delay of implementation start dates raised some questions, “I want to make clear that our commitment to value-based care has never been stronger,” said Liz Fowler, PhD, JD, deputy administrator and director of CMMI, at the start of the NAACOS Spring 2021 Conference.

In an interview with The American Journal of Managed Care^® conducted before NAACOS, the president of payer solutions and value-based care for US Renal Care said the company remains excited about the future of value-based kidney care and is ready to move forward.

CMS delayed the start of the first performance year of its Kidney Care Choices (KCC) payment model, which was supposed to begin April 1. It is now slated for January 1, 2022. The 5-year KCC model aims to encourage better care management for Medicare patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) through financial incentives.

“At a high level, I think we remain super committed to value-based care,” said Nitin Jain, MBA, adding, “it is the wave of the future.”

He said US Renal staffed up to be ready for the April 1 launch and engaged physician partners; he said for the time being, staff have been reassigned to other programs and that the company “remains very excited about doing this at a larger scale.”

The company is talking about value-based arrangements with other payers, an area that has seen increased activity, with or without CMMI. For instance, this year, 2 Blue Cross and Blue Shield groups, in Minnesota and North Carolina, have announced agreements with other kidney care companies.

Jain noted that some patients do not know that they have kidney disease and that US Renal has “patented artificial intelligence–based models” to proactively identify patients.

If dialysis is needed and agreed to by the patient, they discuss different modalities, such as the possibility of home-based dialysis, as well as an optimal start, where the patient’s first experience with dialysis does not take place inside a hospital. With such advance timing, the access for dialysis is ready before the patient actually needs it, while education about the process is ongoing, Jain said.

The CMMI kidney models were announced in 2019. Approximately 37 million Americans have CKD and 725,000 have ESRD, which has long been one of the most expensive and debilitating conditions that affects Medicare beneficiaries.

Not only does dialysis cost $90,000 a year—those awaiting a kidney transplant automatically qualify for Medicare—but the need to travel to a dialysis center multiple times a week disrupts employment and home life. The problem is becoming more acute as demand for dialysis is increasing as rates of diabetes and obesity rise and the population ages.