Providing seamless coordination:
linking providers and payers
Welcome to the world of CKCC, a model offered by the CMS. The Comprehensive Kidney Care Contracting (CKCC) model, developed for kidney care solutions, allows practices and payers to share in the cost savings of managing chronic kidney disease patients.
As the nation's largest integrated kidney care platform, Panoramic Health is here to help walk you through how this process works and explain in detail why the CKCC is important to your patient care.
Although navigating the CKCC model can be complex, Panoramic Health can help. We've put together this comprehensive guide for understanding the CKCC model from start to finish.
What is the CKCC model?
The CKCC model-Comprehensive Kidney Care Contracting-is a value-based approach to kidney care that brings together multiple providers under one contract. It's designed to allow patients with kidney disease to choose where they receive their treatment while still providing seamless coordination between the different providers who are treating them and managing their care.
The goal of this model is to create better outcomes, improve quality, and reduce costs for patients with chronic kidney disease (CKD) stages 4 and 5 and end-stage renal disease (ESRD) by supporting nephrologists to promote the following practices:
•Slowing the progression of kidney disease
•Opting for transplantation instead of dialysis when appropriate
•Preparing patients for dialysis if need be
•Implementing the shift towards home-based treatment as
outpatients as opposed to inpatient hospitalizations
outpatients as opposed to inpatient hospitalizations
•Slowing the progression of kidney disease
•Opting for transplantation instead of dialysis when appropriate
•Preparing patients for dialysis if need be
•Implementing the shift towards home-based treatment as outpatients as opposed to inpatient hospitalizations
The patients chosen CKCC entity will encompass all kidney care services that are needed, including labs, tests, doctor's visits, any procedures, and any supply costs that these services may require. Alternative screening services the patient may need, such as diabetes, blood pressure, and cholesterol tests will also be covered.
The CKCC entity will ensure that patients are not further burdened with out-of-pocket costs due to receiving Treatment (i.e., dialysis or other procedures) from different facilities or providers. In terms of payment, patients will not need to pay individually with their health insurance plans for services during the treatment course. Rather one provider under one contract payment system will cover the costs.
CKCC is a risk-adjusted, shared savings model that encourages onsite management of dialysis eligibility, education, and patient navigation. If a practice's performance exceeds the average for dialysis provider performance, it will receive performance payments. It can also benefit from lower rates of hospitalization among patients with CKD or ESRD.
CKCC offers practices:
•A risk-limited opportunity to participate in value-based care and
drive healthcare transformation for patients with chronic kidney disease (CKD).
drive healthcare transformation for patients with chronic kidney disease (CKD).
•The ability to receive monthly reports detailing local trends in renal
care services utilization by Medicare beneficiaries.
care services utilization by Medicare beneficiaries.
•A risk-limited opportunity to participate in value-based care and drive healthcare transformation for patients with chronic kidney disease (CKD).
•The ability to receive monthly reports detailing local trends in renal care services utilization by Medicare beneficiaries.
Additionally, it gives practices an opportunity to improve outcomes for their patients through incremental performance payments. For example, practices that participate in a Primary Care Medical Home (PCMH) will receive payments if one or more CKD patient is enrolled on the panel and the patient meets specific health criteria.
The program will pay any practice a base fee on each CKD patient that meets these criteria plus payments if they meet quality metrics outlined by the Centers for Medicare & Medicaid Services with regards to diabetes management, hypertension control, and other key areas of care.
What is the Kidney Care Choices Model (KCC)?
The Kidney Care Choices Model (KCC) was developed by the Centers for Medicare and Medicaid Services in collaboration with health care providers, community organizations, patients and their families, donors, and other stakeholders.
It aims to develop an integrated kidney care system that includes patient education, prevention, diagnosis, and treatment programs as well as follow-up services for chronic kidney disease (CKD) and strengthen community health services so that giving patients better access to quality health care services provided at the community level.
There are four options included in the Kidney Care Choices Model (KCC), and these are:
- •CMS Kidney Care First (KCF) Option
- •Comprehensive Kidney Care Contracting (CKCC) Graduated Option
- •Comprehensive Kidney Care Contracting (CKCC) Professional Option
- •Comprehensive Kidney Care Contracting (CKCC) Global Option
Nephrologists and nephrology practices are at the heart of the CMS kidney care first option (KCF), with payment paid to participants as per the quality of care and outcome (30% more or 20% less), as for the Comprehensive Kidney Care Contracting (CKCC) there are three different options. Still, they generally involve pairing up nephrology practices with other care providers. These three different options differ depending on the total cost of care and risk, as follows:
- •Comprehensive kidney Care Contracting (CKCC) Graduated Option - Lesser reward associated with upside-only risk
- •Comprehensive Kidney Care Contracting (CKCC) Professional Option - Equal shared reward and risks
- •Comprehensive Kidney Care Contracting (CKCC) Global Option - Total cost of care
Even though these programs have different strategies, they are similar in fostering patient treatment success, whether by reducing costs like CKCC or raising performance like KCF.
The Kidney Care Choices Model (KCC) was developed by the Centers for Medicare and Medicaid Services in collaboration with health care providers, community organizations, patients and their families, donors, and other stakeholders.
It aims to develop an integrated kidney care system that includes patient education, prevention, diagnosis, and treatment programs as well as follow-up services for chronic kidney disease (CKD) and strengthen community health services so that giving patients better access to quality health care services provided at the community level.
There are four options included in the Kidney Care Choices Model (KCC), and these are:
- •CMS Kidney Care First (KCF) Option
- •Comprehensive Kidney Care Contracting (CKCC) Graduated Option
- •Comprehensive Kidney Care Contracting (CKCC) Professional Option
- •Comprehensive Kidney Care Contracting (CKCC) Global Option
Nephrologists and nephrology practices are at the heart of the CMS kidney care first option (KCF), with payment paid to participants as per the quality of care and outcome (30% more or 20% less), as for the Comprehensive Kidney Care Contracting (CKCC) there are three different options. Still, they generally involve pairing up nephrology practices with other care providers. These three different options differ depending on the total cost of care and risk, as follows:
- •Comprehensive kidney Care Contracting (CKCC) Graduated Option - Lesser reward associated with upside-only risk
- •Comprehensive Kidney Care Contracting (CKCC) Professional Option - Equal shared reward and risks
- •Comprehensive Kidney Care Contracting (CKCC) Global Option - Total cost of care
Even though these programs have different strategies, they are similar in fostering patient treatment success, whether by reducing costs like CKCC or raising performance like KCF.
Why CKCC?
The decision to implement the Comprehensive Kidney Care Contracting (CKCC) model is mainly due to the way it organizes kidney care by focusing on the patient rather than the disease, CKCC is specifically designed to address the unique needs of people with chronic kidney disease (CKD), so they can get the care they need no matter where they live.
The CKCC model includes:
•Comprehensive Kidney Care Program (CKCP)
•Comprehensive Kidney Care Entity (CKCE)
•Comprehensive Kidney Care Contracting Entity (CKCCE)
•Comprehensive Kidney Care Choices Model (KCC)
•Comprehensive Kidney Care Program (CKCP)
•Comprehensive Kidney Care Entity (CKCE)
•Comprehensive Kidney Care Contracting Entity (CKCCE)
•Comprehensive Kidney Care Choices Model (KCC)
What is a Kidney Care Entity (KCE)?
A Kidney Care Entity (KCE) is an entity that has been designated as an accountable care organization (ACO) by Medicare or Medicaid or has been recognized as a Qualified Acute Care Hospital under the Medicare Inpatient Prospective Payment System (IPPS).
What are the benefits of the CKCC model?
Under the CKCC model, all providers who provide services to patients living with CKD are contracted with the state or local government entity. The entities have complete responsibility for contracting providers and paying them for services provided, as well as for oversight of the system overall. This contracting approach creates several benefits:
•Helps people with kidney disease understand everything they need to know about their treatment.
•Enables them to make choices about their care that fit their unique situation.
•Helps them navigate the health system so they can get the care they need when they need it most.
•It reduces fragmentation by creating one payer per patient instead of multiple payers throughout their care experience. This allows providers to coordinate more effectively across all phases of treatment, from diagnosis through dialysis and transplantation if needed.
•It provides incentives for providers who provide high-quality patient experience at lower costs than those who don't deliver on both fronts simultaneously-so everyone has an incentive to focus on value instead of volume alone.
•Helps people with kidney disease understand everything they need to know about their treatment.
•Enables them to make choices about their care that fit their unique situation.
•Helps them navigate the health system so they can get the care they need when they need it most.
•It reduces fragmentation by creating one payer per patient instead of multiple payers throughout their care experience. This allows providers to coordinate more effectively across all phases of treatment, from diagnosis through dialysis and transplantation if needed.
•It provides incentives for providers who provide high-quality patient experience at lower costs than those who don't deliver on both fronts simultaneously-so everyone has an incentive to focus on value instead of volume alone.
Benchmarks for CKCC success
Since the Comprehensive Kidney Care Contracting (CKCC) model is relatively new and still in the process of implementation across many entities, there are some considerations to apply that can significantly help in its success and effectiveness, and these include the following:
•Potential risk management: This is accomplished by proactively intervening to prevent unnecessary health conditions or complications that are expected to happen to patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD).
•Cooperative ecosystem: This can happen when there are collective efforts from all the healthcare team, whether they are physicians, nurses, assistants, and dietitians. This can further help optimize patient care and accommodate patients' needs.
•Multidisciplinary team-valued approach: Having a multidisciplinary team approach ensures that the patient is being consistently monitored by care providers from many specialties. This is especially critical since it's prevalent for chronic kidney disease patients to have other associated comorbidities that can lead to unwanted complications.
•Access to technology: Access to new technology resources can facilitate care and organization for the clinical care team responsible for tending to patients.
•Potential risk management: This is accomplished by proactively intervening to prevent unnecessary health conditions or complications that are expected to happen to patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD).
•Cooperative ecosystem: This can happen when there are collective efforts from all the healthcare team, whether they are physicians, nurses, assistants, and dietitians. This can further help optimize patient care and accommodate patients' needs.
•Multidisciplinary team-valued approach: Having a multidisciplinary team approach ensures that the patient is being consistently monitored by care providers from many specialties. This is especially critical since it's prevalent for chronic kidney disease patients to have other associated comorbidities that can lead to unwanted complications.
•Access to technology: Access to new technology resources can facilitate care and organization for the clinical care team responsible for tending to patients.
How can Panoramic Health help CKD and ESRD patients, Practices, and Payers?
Panoramic Health makes CKCC a reality. We have the technology and expertise to make this happen, but more importantly, we understand the needs of our business partners, our clients, our patients, and their families.
Moreover, Panoramic Health is committed to investing in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) by leveraging the CKCC model and relevant value-based approaches paving the way to an improved future in kidney care.
