Most ESCOs were financially successful in 1st year

First-year results from Medicare’s Comprehensive ESRD Care Model show that 12 of the 13 ESRD Seamless Care Organizations (ESCOs) that contracted with the agency for the five-year project received sharing savings—one as much as $12.3 million.

The results, released by the Centers for Medicare & Medicaid Services on Oct. 13, cover October 2015 through December 2016. The shared savings represent how much an ESCO retains after providing patient care in the demonstration. The ESCOs and Medicare receive a percentage of the savings.

Eight of 12 of the participants earned between $1.45 million and $4.7 million in the first year. The remaining four earned between $5.6 million to $12.3 million––the highest earner in the group being an ESCO operated by DaVita in the Philadelphia area (see chart).

According to an Oct. 18 Modern Healthcare article, CMS determined that the model saved the ESRD Program $75 million, "That's more than the $68 million saved by Pioneer ACOs, and the $48 million saved by NextGen ACOs in the same period," the article noted.

The ESRD cost savings "support the need for more specialty payment models," Christopher Huryn, a health care lawyer at the law firm Brouse McDowell told Modern Healthcare. "The most potential savings exist in the medical specialties that provide, and in the patient populations that require, the most costly care."

"The big saver, by far, was the [ESRD model]," David Muhlestein, chief research officer at Leavitt Partners, told Modern Healthcare. "Perhaps there is more opportunity to focus on disease-specific programs." He speculated in the article that the ESRD model may have outperformed other ACO programs because participating providers knew upfront that they were accountable for specific patients. In other ACO models, he said, patients are retroactively assigned to the programs at the end of the year.

There are now 37 ESCOs in the demonstration, with new participants added in January of this year. Those additional organizations were approved and began participating in the demonstration after CMS indicated that it wanted more smaller, independent providers like Rogosin Institute, the smallest dialysis provider with an ESCO in the group, to be part of the project. With all the ESCOs now underway, the demonstration represents more than 33,000 patients.

Determining a provider’s success

In the demonstration, dialysis providers can earn shared shavings in two ways:

Reduce the cost of patient care compared to the established base line set by CMS at the beginning of the demonstration

Perform well in a series of quality measures established by CMS for the project. The 15 clinical measures include diabetic foot and eye exams, evaluating patients for depression, improving medication adherence, influenza immunizations, assisting patients with smoking cessation, reduce patient falls, and track how patients responded to surveys about satisfaction with their care. The first year served as a "reporting" process on the clinical measures; in years 2 and 3 of the project, the measures will have a greater impact on how much providers receive in shared savings.

View the first year results of the ESCO demonstration here.