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Rogosin Kidney Care Alliance, LLC

End-Stage Renal Disease Seamless Care Organization

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WHAT IS THE CEC INITIATIVE?

The Comprehensive End-Stage Renal Disease Care (CEC) Model was announced by the Centers for Medicare & Medicaid Services (CMS) in February 2013. The CEC Model is a demonstration program that is designed to identify, test and evaluate new ways to improve care for people with Medicare and living with end-stage renal disease (ESRD). The CEC Model aims to improve health care delivery and improve clinical outcomes while reducing the overall cost of care.

People living with ESRD have significant care needs. These individuals constituted 1.1% of the Medicare population and accounted for an estimated 5.6% of Medicare spending, totaling over $8.6 billion in 2012 (Centers for Medicare & Medicaid Services). These high costs are often the result of underlying disease complications and multiple co-morbidities, which often lead to high rates of hospital admission and readmissions, as well as a mortality rate that is much higher than the general Medicare population. Because of these complex health needs, beneficiaries often require visits to multiple providers and follow multiple care plans, which can be challenging for beneficiaries if care is not coordinated. Through enhanced care coordination by the Rogosin Kidney Care Alliance ESCO, these individuals will have a more patient-centered care experience, which is ultimately expected to improve health outcomes.

WHAT IS AN ESCO?

An ESRD Seamless Care Organization (ESCO) is a partnership among groups of health care providers and suppliers that is formed to evaluate a new payment model and care delivery method specifically for people with Medicare who are living with ESRD.

An ESCO is formed by a partnership among Medicare enrolled dialysis facilities, nephrologists and/or nephrology practices, and other Medicare enrolled providers and suppliers located in a contiguous geographical area. Through the ESCO model, these partners are able to work together to improve communication, coordination of care, and access to services and to enhance patient-centered care.

HOW DOES THIS HELP PATIENTS?

The principal goal of the model is to provide people living with ESRD an improved care experience. To ensure beneficiaries receive this high quality care, CMS has developed a model that puts people with Medicare at the center of their care:

Putting the Person First

The model creates new incentives for providers to work together to improve the care that people with Medicare/ESRD receive.

Beneficiary Choice

People with Medicare matched to an ESCO will maintain all the rights and benefits of beneficiaries in Medicare fee-for-service, including the freedom to see any health care provider that accepts Medicare.

Active Monitoring

CMS will closely and routinely analyze data assessing the utilization of services of these beneficiaries. This monitoring will occur through the use of audits and other actions as necessary. People with Medicare will be surveyed each year to assess their experience with the new initiative.

CMS also believes it is important that beneficiaries and their advocates be meaningful partners in improving care delivery. The governing body of each ESCO must include at least one patient representative or independent consumer advocate. Through this representation, CMS will ensure that the beneficiary and consumer representatives participate in all strategic decisions made by the organizations and that the beneficiary perspective is integrated into operations.

HOW IS THIS PAYMENT MODEL DIFFERENT?

Under the Comprehensive ESRD Care model, participating organizations will be held financially accountable for delivering high quality care and improving the health outcomes of their aligned beneficiaries. Participating ESCOs will be required to report on a variety of care delivery and health outcome measures across the continuum of care, not only those related to ESRD services.

ESCOs that do not achieve a high standard of quality will be ineligible to share in savings generated from the model, and may also be terminated from participation. CMS will also require that ESCO participants that are dialysis facilities receive a Total Performance Score (TPS) assigned by the ESRD Quality Incentive Program (QIP) that meets or exceeds a certain minimum level in order to be eligible for any shared savings.
For more information on the CEC Initiative, please visit the Centers for Medicare & Medicaid Services website at:
http://innovation.cms.gov/initiatives/comprehensive-ESRD-care/.


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.