Kidney Care Choices model shows promise for future of value-based care
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Key takeaways:
- The federal value-based Kidney Care Choices model for kidney disease is now in year 4.
- Result from year 1 show success for the program.
The journey toward a new sustainable, government-backed value-based model for kidney disease is now in year 4 with early results showing promise for the future.
The hope is the model can be made permanent by CMS by proving it can either improve quality and maintain costs, improve quality and reduce costs, or reduce costs and maintain quality.
Value-based care emerged as an alternative to fee-for-service (FFS) models in primary care to reward quality over quantity by aligning provider incentives with patient outcomes in a pay-for-performance arrangement. Now value-based specialty care, including for kidney disease, is quickly catching up, and early results from the federal value-based Kidney Care Choices (KCC) model show it is already starting to pay off. This model is a bellwether for continued adoption of value-based kidney care and value-based specialty care more broadly.
Early results from the KCC model
In its first year, the KCC model implemented by the Center for Medicare and Medicaid Innovation (CMMI) pro-vided shared savings as an incentive to providers who were able to reduce the cost of care while simultaneously meeting certain quality targets for Medicare patients with late-stage CKD and end-stage kidney disease. Providers were graded on their percentage of “optimal starts,” defined as a transition from CKD to ESKD with a preemptive kidney transplant, with initiation of a home dialysis modality or with a move into an in-center dialysis program with a functioning permanent access.
Additionally, providers had to implement a depression screening program and enhance patient engagement as measured through the Patient Activation Measure. This was a major pivot from the existing FFS nephrology model, but providers did not shy away from the challenge. Almost 2,900 nephrology professionals from 33 states and the District of Columbia chose to participate through 55 kidney care entities.
In October, CMMI released results from the first year showing substantial quality improvements while maintaining costs. This is an exciting first step in a program that is reshaping how physicians approach care management for this often costly and complex patient population.
A report by the Lewin Group, commissioned by CMS, noted some key findings in evaluation of the first per-formance year of the KCC model. This included an increase in home dialysis, particularly peritoneal dialysis, and optimal dialysis starts, a key quality indicator. Placement of patients on waitlists for transplant also increased sig-nificantly, hopefully signaling a trend toward increasing transplant rates as the program continues.
While costs to Medicare did not change substantially on average across the program, individual providers were able to demonstrate both exceptional quality results while driving savings. This is a sign that with the right approach and the right partners, these incentives to improve quality while reducing costs can drive meaningful results.
How we achieved a perfect quality score
Based on the experience of our practice, I encourage everyone to remember that it is still early in the implemen-tation and measurement of the KCC model. Yet these first-year results suggest significant positive impacts, with the promise of further gains moving forward.
The truth is most nephrology practices have become efficient in the FFS world, which is predominantly focused on episodic care and increasing the volume of encounters performed. Unfortunately, this leads to unrecognized gaps in care that all too often lead to suboptimal patient outcomes. There is an opportunity to change that with value-based care, and we saw the KCC model as a prime opportunity to begin a transformation of our practice to value.
We partnered with Interwell Health, a value-based kidney care provider, to form the Eastern North Carolina kidney care entity and entered the professional payment option of the Comprehensive Kidney Care Contracting Option, taking on some downside risk. Together, we worked on building a care team and workstreams to help us close gaps in care and focus on key quality measures to achieve strong results.
Ultimately, we earned recognition by CMS as a high performer with a 100% total quality score and some of the highest marks across the country for measures including optimal starts, patient activation and depression screening. Most importantly, this performance means better outcomes for our patients. We also believe it provides further proof that focusing on and investing in value-based care models can consistently produce quality outcomes and cost savings.
Future of value-based kidney care
The KCC model is experimental and new, but it is another step in the right direction. CMMI Deputy Director Ellen Lukens has said the KCC model enables nephrologists to effectively act as “quarterbacks” of their patients’ care. Because of the complexity of kidney disease, this empowerment allows us to increase care coordination that posi-tively impacts patients’ overall health. The emphasis of the model on prevention, slowing progression and 360-degree support enables treatment of the whole person, not just the disease.
For our practice, participating in the KCC model has been a great opportunity to learn how to be successful in value-based care. By partnering with a value-based care provider, we received specific resources, such as embedded renal care coordinators, to fill our practice gaps at the pace we needed to continue to build on our success. Using an electronic health record system designed for nephrologists and value-based workflows, we are leveraging data and analytics at scale to get a population health view of our patients, ensuring we reach the right patients at the right time to reduce hospitalizations and readmissions.
The entire industry understands there are challenges with navigating the transition away from the traditional health care FFS model. But the first year of KCC results provide initial evidence that value-based care works and better care at a lower cost is possible at scale. I am confident that optimism and momentum will grow as evidence, such as the KCC numbers, encourage CMS and private payers that value-based care is the way forward for the entire health care system.
I encourage you to look deeper at the results now published on the CMMI website. Hopefully, year 2 will show another step forward for patients and another step toward making these value-based government models permanent. Our practice is all in on value-based care, and we hope to be an example for others, so we can work together to make the health care system work better for everyone.
Reference:
CMS. Kidney Care Choices (KCC) model first annual evaluation report, performance year 2022—executive summary. https://www.cms.gov/kcc-model-eval-ann-rpt-1-exec. Published Aug. 2024. Accessed Dec. 3, 2024.
For more information:
M. Carney Taylor Jr, MD, MBA, was a practicing nephrologist for 24 years before joining Interwell Health’s medical office in January, 2025. During the first 3 years of the KCC model, he was co-president of Eastern Nephrology Associates. He can be reached at carney.taylor@interwellhealth.com.
Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.
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