Considering an integrated nephrology care delivery model: six principles for quality

Area of Science:

• Nephrology
• Health Policy
• Healthcare Management

Background:

• The Medicare Shared Savings Program (MSSP) aims to improve patient care and reduce costs through Accountable Care Organizations (ACOs).
• Initial participation in the MSSP reflects adjustments by the Centers for Medicare and Medicaid Services (CMS) to address program criticisms regarding burden and risk.
• However, the final rule did not adequately address concerns from subspecialty societies, particularly the American Society of Nephrology (ASN), regarding the care of patients with multiple chronic comorbidities and complex conditions.

Purpose of the Study:

• To highlight the unaddressed concerns of the nephrology community regarding the care of kidney disease patients within the ACO framework.
• To propose principles for pilot programs and demonstration projects aimed at integrating nephrology care delivery models within ACOs.
• To ensure that patients with kidney disease, including those with chronic kidney disease (CKD), kidney transplants, and end-stage renal disease (ESRD), receive appropriate and individualized care within ACOs.

Main Methods:

• Analysis of the final rule for the Medicare Shared Savings Program and its implications for patients with kidney disease.
• Development of a set of principles by the ASN ACO Task Force for potential pilot programs or demonstration projects.
• Identification of key elements for an integrated nephrology care delivery model.

Main Results:

• Significant concerns raised by subspecialty societies, including the ASN, regarding the care of patients with multiple comorbidities and complex/end-stage conditions remain unaddressed in the final ACO rule.
• The Centers for Medicare and Medicaid Innovation (CMMI) offers an opportunity to test ACO concepts within the kidney disease patient population.
• The ASN ACO Task Force has outlined essential principles for future integrated nephrology care models.

Conclusions:

• ACOs require guidance and partnership from the nephrology community to effectively identify and manage patients with kidney disease.
• Pilot programs and demonstration projects are crucial for testing integrated nephrology care delivery models within the ACO framework.
• Key principles for such models include preserving nephrologist leadership, encompassing comprehensive CKD/transplant/ESRD care, diverse dialysis participation, research facilitation, and robust monitoring systems.