The face of kidney care in the United States is experiencing a seismic shift, rapidly moving away from a traditional fee-for-service model and toward a value based-care model centered around patient outcomes. While this sentiment is true for most other subsets of healthcare, it’s particularly pronounced in kidney care due to many significant efforts Centers for Medicare and Medicaid Services (CMS) has made in recent years to improve quality of care for Medicare beneficiaries with Chronic Kidney Disease (CKD) and End-stage Renal Disease (ESRD).
These efforts include the ESRD Treatment Choices (ETC) Model, as well as the value-based care Kidney Care Choices (KCC) model, which offers four payment options including the CMS Kidney Care First (KCF) Option, Comprehensive Kidney Care Contracting (CKCC) Graduated Option, CKCC Professional Option, and CKCC Global Option. Building upon the existing Comprehensive End Stage Renal Disease Care Model structure, KCC adds strong financial incentives for providers. In turn, KCC is encouraging nephrologists to increase their care coordination efforts in pursuit of later and more effective starts on dialysis, and an increased number of successful kidney transplants.
To achieve success under the KCC program, providers caring for CKD and ESRD patients should focus on:
- Reducing Acute Hospitalization Utilization and the Total Cost of Care: This can be done by preventing avoidable readmissions and preventing unnecessary emergency department (ED) utilization. In the KCC program, doing so will result in greater savings versus the benchmark.
- Ensuring Top Performance in Quality Measures: To maximize performance adjustments and earn back quality withholds, it’s important that participants in the KCC models provide high-quality care by engaging beneficiaries over time. For example, the time after an acute event when a patient may be seeking care or open to behavior changes, offers a meaningful opportunity to make strides in closing gaps.
- Minimizing Leakage Rates: KCC participants can minimize outmigration (or “leakage”) rates through the identification of beneficiary utilization outside of their practice and engagement of the patient with appropriate care in their practice. To achieve high beneficiary retention rates, KCC participants should engage beneficiaries at key touch points during their care journey.
Actionable Insights Begin with Real-time ADT Data
Accomplishing these expanding measures of care starts with having the proper tools, resources, and data to identify in real time when beneficiaries are discharged from the hospital or admitted to a post-acute facility. From there, KCC program participants can reach out to the patient or facility to ensure the appropriate post-discharge care is delivered, educate the patient on resources and appropriate ED utilization, or work with the admitting facility to ensure the appropriate length of stay (LOS).
At Bamboo Health, our extensive infrastructure and network support the exchange of applications, information, and actionable insights in more than one billion patient encounters per year nationwide to provide kidney care providers with the ability to thrive under the KCC program. We enable provider success in KCC and other value-based kidney care models by optimizing encounter efficiency, reducing avoidable utilization, and ensuring patients are receiving critical care when they need it.
Our Pings solution for real-time admission, discharge, and transfer (ADT) data provides visibility into patient care events that can be used to help drive targeted interventions, facilitate reduction in acute hospital utilization and total per capita cost, as well as support quality performance improvement and beneficiary retention. These real-time insights into patients’ care journeys also allow providers and clinicians to collaborate on shared patient cases for the delivery of comprehensive value-based care in alignment with the KCC program model.
For additional information, download Bamboo Health’s Pings for Kidney Care Overview or read about our partnership with Strive Health, the national leader in value-based kidney care, to optimize care coordination for improved kidney disease patient outcomes throughout Illinois, North Carolina, New Jersey, and Michigan.