Improving Care Coordination

Many individuals with kidney failure are also living with several comorbidities, such as diabetes and hypertension, which impacts their care and health outcomes. Traditional Medicare creates silos among the health care providers that make it difficult to coordinate treatments for these various conditions. Yet, as the Congress has already recognized, improving care coordination leads to better patient outcomes. The legislation seeks to incentivize improving the coordination of care in three ways:

  1. Providing Access to Medicare Advantage Plans. Under current law, individuals who develop kidney failure are not permitted to enroll in Medicare Advantage (MA) plans. However, the Medicare Payment Advisory Commission (MedPAC) has recommended that Congress eliminate the restriction against ESRD beneficiaries enrolling in MA plans to provide ESRD beneficiaries with the same freedom of choice and access to improved coordinated services as other Medicare-enrolled individuals.
  2. Making the Medicare Advantage Special Needs Plans (SNPs) Permanent. SNPs have shown how better coordination of care can improve patient outcomes. However, the annual need for reauthorization fails to provide the certainty needed to invest in maintaining ESRD SNPs. Permanently reauthorizing ESRD SNPs would ensure stability and protect patient access to these plans.
  3. Establishing a Voluntary Coordinated Care Program. The most direct way to improve care is to incentivize nephrologists, renal dialysis facilities, and providers of services to develop innovative coordinated care organizations that provide the full range of clinical and support services to patients receiving dialysis treatments. It is important that the structure of this program focuses on the savings achievable from non-dialysis-related services and includes market-based benchmarks to establish appropriate and meaningful incentives.

KCP Comment Letters


Policy Documents

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