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Road Map to Integrated Care / ESCO

Sponsored by Renal Services Exchange
The Centers for Medicare & Medicaid Services (CMS) is officially announcing a Request for Applications (RFA) for the Comprehensive ESRD Care (CEC) Model. Applicants will have the opportunity to apply to join the Model starting in its second year, on January 1, 2017.

The CEC Model is designed to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease (ESRD). Through the CEC Model, CMS will partner with health care providers and suppliers to test the effectiveness of a new payment and service delivery model in providing beneficiaries with person-centered, high-quality care. Dialysis providers, nephrologists, and other providers form ESRD Seamless Care Organizations (ESCOs), which are responsible for coordinating care and improving health outcomes for aligned beneficiaries, and are eligible for shared savings when total cost of care is reduced and quality is improved.

The CEC Model currently has 13 ESCOs participating in the model, including 12 ESCOs from Large Dialysis Organizations (LDOs) and 1 from a non-Large Dialysis Organization (Non-LDO).

Background
The CEC Model is authorized under Section 1115A of the Social Security Act (added by section 3021 of the Affordable Care Act), which established the Center for Medicare and Medicaid Innovation (the Innovation Center) to test innovative payment and service delivery models that have the potential to reduce Medicare, Medicaid, and Children's Health Insurance Program expenditures while maintaining or enhancing the quality of beneficiaries' care.

Eligible Applicants
The CEC Model seeks a diverse set of ESCOs in order to improve the overall model test. This is an open solicitation for both LDOs and Non-LDOs.
In order to be eligible, ESCOs must include:
  • Dialysis facilities from a single dialysis company, either LDO or non-LDO
  • Nephrologists, who will be required to serve as owners of the ESCO and, if the ESCO participates in a two-sided financial track, be held responsible for downside risk.
ESCOs are encouraged to include additional providers across the full spectrum of care, given that they are held responsible for the full set of Medicare Part A and B services. These may include:
  • Hospitals
  • Physicians
  • Long-term care facilities
  • Vascular Surgeons
For more information about the CEC Model, please visit: https://innovation.cms.gov/initiatives/comprehensive-ESRD-care/