Comprehensive ESRD Care Model

More than 700,000 Americans have ESRD and require life sustaining dialysis treatments several times per week. Many beneficiaries with ESRD suffer from poorer health outcomes, often the result of underlying disease complications and multiple co-morbidities. These can lead to high rates of hospital admission and readmissions, as well as a mortality rate that is higher than that of the general Medicare population. 

According to the United States Renal Data System, in 2016 ESRD beneficiaries comprised less than 1% of the Medicare population, but accounted for an estimated 7.2% of total Medicare fee-for-service spending, totaling over $35.4 billion. Because of their complex health needs, beneficiaries often require visits to multiple providers and follow multiple care plans, all of which can be challenging for beneficiaries if care is not coordinated. The CEC Model sought to create incentives to enhance care coordination and to create a person-centered, coordinated, care experience, and to ultimately improve health outcomes for this population.

Model Details

In the CEC Model, dialysis clinics, nephrologists and other providers joined together to create an ESCO to coordinate care for matched beneficiaries. ESCOs are accountable for clinical quality outcomes and financial outcomes measured by Medicare Part A and B spending, including all spending on dialysis services for their aligned ESRD beneficiaries. The model encouraged dialysis providers to think beyond their traditional roles in care delivery and supported them as they provided patient-centered care that addressed beneficiaries’ health needs, both in and outside of the dialysis clinic.

The CEC Model included separate financial arrangements for larger and smaller dialysis organizations. Large Dialysis Organizations (LDOs), which had 200 or more dialysis facilities, were eligible to receive shared savings payments. These large dialysis organizations were liable for shared losses, and had higher overall levels of risk compared with their smaller counterparts.

Non-large dialysis organizations (Non-LDOs) included chains with fewer than 200 dialysis facilities, independent dialysis facilities, and hospital-based dialysis facilities. Non-LDOs will had the option of participating in a one-sided track where they were able to receive shared savings payments, but were not liable for payment of shared losses, or participating in a track with higher risk and the potential for shared losses. The one-sided track was offered in recognition of non-LDOs more limited resources.

The CEC Model began October 2015 and ended March 31, 2021. The CEC Model conducted a solicitation in 2016 to add more ESCOs, that started in PY 2 of the model on January 1, 2017. There are no plans for another round of solicitation. However, the Kidney Care Choices (KCC) Model builds upon the CEC Model structure 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 CEC Model LDO payment track and Non-LDO two-sided payment track were considered Advanced APMs for the purpose of the Quality Payment Program. For more information on APMs, please visit the Quality Payment Program website.

Stay up to date on the latest CEC Model updates by subscribing to the CEC Model listserv.

Evaluation

Latest Evaluation Report

• Two Pager: At-A-Glance Report (PDF)
  • White Paper - Synthesis of Evaluation Results Across 21 Medicare Models (PDF)  |  Slides (PDF)  |  Recording (MP4)  |  Transcript (PDF)  

Prior Evaluation Reports

• Two Pager: CEC Annual Evaluation Report - Performance Year 5 Findings-At-A-Glance Report (PDF)
  • CEC Annual Evaluation Report and Appendices - Performance Year 5 (PDF)
• Two Pager: CEC Annual Evaluation Report - Performance Year 4 Findings-At-A-Glance Report (PDF)
  • CEC Annual Evaluation Report - Performance Year 4 (PDF)
  • CEC Annual Evaluation Report - Performance Year 4 Appendices (PDF)
• Two Pager: CEC Annual Evaluation Report - Performance Year 3 Findings-At-A-Glance Report (PDF)
  • CEC Annual Evaluation Report - Performance Year 3 (PDF)
  • CEC Annual Evaluation Report - Performance Year 3 Perspective Report (PDF)
• Two Pager: CEC Annual Evaluation Performance Year 2 Findings-At-A-Glance Report (PDF)
  • CEC Annual Evaluation Report - Performance Year 2 (PDF)
  • CEC Annual Evaluation Report - Performance Year 2 Appendices (PDF)
• CEC Annual Evaluation Report - Performance Year 1 (2015 - 2016) (PDF)

Financial and Quality Results

• CEC Financial and Quality Results Performance Year 5 (2020) (XLSX)
• CEC Financial and Quality Results Performance Year 4 (2019) (XLSX)
• CEC Financial and Quality Results Performance Year 3 (2018) (XLS)
• CEC Financial and Quality Results Performance Year 2 (2017) (XLSX)
• CEC Financial and Quality Results Performance Year 1 (2015 - 2016) (PDF)

Learning System Case Studies

• Fresenius Kidney Care's Home Dialysis Program (PDF) (January 2021)
• Atlantic Dialysis Management Services' Patient Navigator Program (PDF) (February 2020)
• Center's for Dialysis Care's Patient Advisory Committees (PDF) (February 2020) 
• Rogosin Institute's Initiative to Promote Health Literacy (PDF)

Additional Research 

• The Medicare CEC Model: Using Lessons Learned To Improve Value-Based Kidney Care

Additional Information

General Information

• Fact Sheet (PDF)
• Attribution Fact Sheet (PDF)
• Press Release
• Frequently Asked Questions (PDF)
• CEC Performance Year 2 Request for Applications (PDF)
• Fact Sheet: Comprehensive ESRD Care Model
• CEC Quality Performance LDO (PDF)
• CEC Quality Performance Non-LDO (PDF)
• CEC 2018 Quality Measure Set and Weights (PDF)
• CEC 2019 Quality Measure Set and Weights (PDF)
• Archived Materials

Events

• Webinar: Updates to the Innovation Center Kidney Models (March 2, 2022) - Transcript (PDF)  |  Slides (PDF)  |  Recording (MP4)

Toolkits

• Beneficiary Engagement Toolkit (PDF)
• Care Coordination Toolkit (PDF)
• Provider Engagement Toolkit (PDF)
• Care Transformation Toolkit (PDF) (January 2021)

Tip Sheet

• Home Dialysis Tip Sheet (PDF)

Questions about the Comprehensive ESRD Care Model can be sent to ESRD-CMMI@cms.hhs.gov.