The Centers for Medicare & Medicaid Services has announced an initiative designed to identify, test and evaluate new ways to improve care for Medicare beneficiaries with end-stage renal disease.
Through the Comprehensive ESRD Care initiative, CMS will partner with healthcare providers and suppliers to test the effectiveness of a new payment and service delivery model in providing these beneficiaries with patient-centered, high-quality care.
“This initiative puts Medicare beneficiaries living with end-stage renal disease at the center of their care,” CMS Acting Administrator Marilyn Tavenner, RN, BSN, MHA, said in a news release. “Through enhanced care coordination, these beneficiaries will have a more patient-centered care experience, which will ultimately improve health outcomes.”
In 2010, patients with ESRD constituted 1.3% of the Medicare population but accounted for an estimated 7.5% of Medicare spending, totaling over $20 billion. These high costs often are the result of underlying disease complications and multiple co-morbidities, such as coronary artery disease and hypertension, which can lead to high rates of hospital admission and readmissions and a mortality rate that is significantly higher than that of the general Medicare population.
Through the Comprehensive ESRD Care Initiative, CMS will enter into agreements with ESRD Seamless Care Organizations, which are groups of healthcare providers and suppliers that will work together to provide beneficiaries with a more patient-centered, coordinated care experience. Participating organizations must include a dialysis facility, a nephrologist and one other Medicare provider or supplier, and must have at least 500 beneficiaries matched to their organization.
Participating organizations will assume clinical and financial responsibility for a group of beneficiaries with ESRD, based on where these beneficiaries receive services. Beneficiaries will retain the right to see any Medicare provider they choose.
The organizations will be evaluated based on their performance on quality measures, which fall under five broad categories: preventive health, chronic disease management, care coordination and patient safety, patient and caregiver experience, and patient quality of life. Organizations that are successful in improving beneficiary health outcomes and lowering the per capita cost of care for beneficiaries will have an opportunity to share in Medicare savings with CMS.
This initiative was developed through consultation with advocates and beneficiaries living with ESRD, healthcare providers and nonprofit organizations, among others.
Interested applicants must file non-binding letters of intent by March 15. Applications to participate in the model are due May 1. For more information, and to see the request for application, visit http://innovation.cms.gov/initiatives/comprehensive-ESRD-care.
The initiative is being run through the CMS Innovation Center, which was created by the Affordable Care Act to test new models of delivering healthcare that may lower costs and improve patient care.