Compare how the Triple Aim of equality, equity, and efficiency has impacted the payment and delivery model you chose against the choices of your peers.
Which aim do you think the reform has the most impact upon? Do you think the model will be able to endure the test of time? How would the model impact you as a healthcare professional?
Patients with kidney disease now tend to follow the most expensive path to ESRD care with very little prevention in disease progression and unplanned start to treatment. The current payment system encourages in-center hemodialysis as a default treatment for patients beginning dialysis. Most patients spend an average of 12 hours a week receiving dialysis and most suffer from poor health outcomes including death and hospitalization. The Kidney Care Choice (KCC) model will expand on the existing Comprehensive End Stage Renal Disease (ESRD) Care (CEC) model. In this model, nephrologists, dialysis facilities and other healthcare providers will collectively form an ESRD- focused accountable care organizations Medicare patients with ESRD. The KCC is designed to help healthcare providers to lower cost and improve the quality of care for patients with ESRD by delaying the need for dialysis and encouraging kidney transplants. In this model, there will be 4 payment plans available to patients:
· 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
The Kidney Care Choice model will start will January 1, 2022 per the CMS.
Volume-Based delivery models have been the standard payment structure in the US, otherwise known as fee-for-service. Incentives for payment to providers and organizations were based on the volume and cost of care that was provided. This type of payment model achieved high-profit margins, with little or no emphasis on improving the quality of care that was given to patients. The shift to Value-Based care is intended to make the quality of care given the primary focus, shifting away from the high-profit margin model. Payments in this Value-Based model are used to now incentivize other objectives like improving quality of care and reducing cost of care. This model is also designed to help healthcare providers manage higher patient volume due to increased access to care, which can eventually lead to less out-of-network services. Special incentives also are given for the population suffering from multiple, chronic conditions. While this shift is far from seamless, efforts should create a major benefit for patients. For organizations establishing their value-based structure, implementation and training may strain resources while continuing to provide care.
The Comprehensive Primary Care Plus program is supported by fifty-two payer partners
such as regional Blue Cross/Blue Shield, United Healthcare, and statewide Medicaid in eighteen regions across the US. The program has five main goals: Access and Continuity, Care Management, Comprehensiveness and Coordination, Patient and Caregiver Engagement and Planned Care and Population Health.
In order to meet all goals, there are three payment models:
· Care Management Free (CMF)- paid by Medicare on a quarterly basis. Payment adjusted based on the care management services for a practice’s specific population.
· Performance-Base Incentive Payment- based on how well a practice performs on patient experience measures, clinical quality measures and total cost of care.
· Payment under the Medicare Physical Fee Schedule- continues the fee-for services (FFS) model, but payment is reduced to account for Medicare shifting a portion of payment into Comprehensive Primary Care Payments (CPCP) quarterly. Eventually the hope is to shift all to CPCP payments and away from FFS (CMS, n.d.)
The Comprehensive Primary Care plus program designated the primary care provider as the “gatekeeper” for the patient, which in turns ensures care continuity and coordination. Primary Care providers identify quality indicators that meet the standards during patient visits, that also align with payer(insurance) expectations. Reduction of unnecessary treatment, procedures, and readmission to hospitals are goals that are aligned with the IHI Triple Aim Initiative.
The CPC+ program has so far been successful with the transition from Volume-Based to Value-Based payment models. The implementation of quality measures with patient visits are now integrated within a practices’ EMR, but since there are multiple EHR and EMR’s, work continues to be able to get shared information across all platforms.