Deep Dive in the Kidney Care Choices (KCC) with CareJourney

Getting Started 

Q: What is Kidney Care Choices (KCC) model? 

A: Kidney Care Choices (KCC) is a voluntary alternative payment model built on top of the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) model structure. The goal of the KCC model is to encourage nephrologists, dialysis facilities, and ESRD healthcare practices to focus on the total care of their patients, and incentivise kidney transplants for chronic kidney disease beneficiaries.

Q: What determines whether a beneficiary is attributable or not under KCC model? 

A: Our methodology defines attributed beneficiaries based on the Request for Applications (RFA) published by CMS. Beneficiaries are defined as attributed to a provider in the model if they are diagnosed  with stage 4 or 5 chronic kidney disease (CKD) or ESRD, or if they were aligned to a participating KCC practice and then received a kidney transplant. 

Q: What are the different payment options under KCC model? 

A: There are four payment options for the KCC Model: Kidney Care FIRST (KCF), or a Framework for Improving Renal disease Support & Treatments, and Comprehensive Kidney Care Contracting (CKCC) which has three options; Graduated, Professional, and Global. These alternative payment models take concepts from the new Direct Contracting and Primary Care First models. 

The KCF payment option differs from the CKCC payment options in a few ways. Only nephrologists and nephrology practices can participate in the KCF model, while CKCC participants are required to include transplant providers and may include dialysis facilities. Additionally, while both KCF and CKCC receive adjusted payments for beneficiaries with CKD 4, 5 and ESRD, as well as the kidney transplant bonus payment, only KCF participants receive a performance based adjustment based on performance of quality and utilization measures as compared to all KCF practices. This performance based adjustment applies to the monthly and quarterly capitated payments. 

Q: How do you determine if a beneficiary is eligible for attribution under KCF?

A: To be eligible for alignment and to remain aligned to a KCF practice for a performance year, beneficiaries must meet all of the following criteria, except where otherwise noted. CareJourney considered the following beneficiary eligibility in attribution calculations.

• Have either late stage CKD (stage 4 or 5) or ESRD, or be a transplant recipient with a functioning kidney who was previously aligned to the KCF practice while the beneficiary had late stage CKD or ESRD. (note: This analysis didn’t included transplant patients, because they would need to receive the transplant after the beginning of the model, which starts April 1, 2021.)
• Be enrolled in Medicare Parts A and B.
• Not be enrolled in a Medicare Advantage plan, cost plan, or other non-Medicare Advantage Medicare managed care plan. • Reside in the United States.
• Receive the plurality of their Monthly Capitation Payments (MCPs) billed in the KCF practice’s market area, defined in section III.B of this RFA (ESRD beneficiaries only).
• Receive the plurality of their CKD care in the KCF practice’s market area (CKD beneficiaries only).
• Be 18 years of age or older.
• Be alive.
• Not have acute kidney injury (AKI).
• Not have already been aligned to a Medicare Accountable Care Organization (ACO) or another participant in a Medicare program/demonstration/model involving shared savings as of the date of alignment for the KCF Option (please refer to Section 14, Overlap, for additional information).
• Not have Medicare as a secondary payer.

Q: For participating entities in the KCF payment option, what are the adjusted payment rates? 

A: Nephrologists and nephrology practices will receive adjusted fixed payments on a per-patient basis, with the payments adjusted based on quality health outcomes for the beneficiaries and utilization across the practice.

For the top 10% of KCF practices, the performance adjustment is up to +30%, while for the bottom 50% of KCF practices that are also in the bottom 25th percentile nationally, the performance adjustment is -20%. The -20% adjustment also applies to practices who don’t pass the Quality Gateway. 

Participating practices will also receive bonus payments for aligned patients who receive a kidney transplant, with bonuses paid out annually over three years while the transplant is successful and the patient is not on dialysis.

Q: What are the requirements for an entity to remain participating in the KCF payment option? 

A: A participating organization must have and maintain a minimum of 500 aligned CKD beneficiaries and 200 aligned ESRD beneficiaries over the life of the model. Beneficiaries can become unaligned if they receive a majority of their visits outside of the participating KCF practice market.

Questions?

Should you have any additional questions, please reach out to your main point of contact at CareJourney for more information and/or additional support regarding this analysis. If you do not have a main point of contact at CareJourney, please reach out to jumpstart@carejourney.com.

More CareJourney JumpStart?

If you want to access more content like the one above, click here. 

About CareJourney

CareJourney is a leading provider of clinically-relevant analytics for value-based networks supporting leading payer, provider, and life sciences organizations across the US. We help these organizations achieve their goals by bringing new, high value insights out of expansive population claims data.

Sources:

1. “Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) Kidney Care Choices (KCC) Model - Request for Applications (RFA).” Centers for Medicare & Medicaid Services, 2019.
2. “Kidney Care Choices (KCC) Model.” Centers for Medicare & Medicaid Services, 2019.
3. “Kidney Care Choices (KCC) Model.” Share, 2020, innovation.cms.gov/initiatives/kidney-care-choices-kcc-model/.
4. “Kidney Care Choices Model: KCF Option.” Centers for Medicare & Medicaid Services, 2020.
5. “Kidney Disease Statistics for the United States.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 1 Dec. 2016, www.niddk.nih.gov/health-information/health-statistics/kidney-disease.
6. Ketchersid, Terry. “KIDNEY CARE CHOICES: TRICK OR TREAT?” Acumen Physician Solutions, 28 Oct. 2019, acumenmd.com/blog/kidney-care-choices-trick-or-treat/.