The Centers for Medicare & Medicaid Services (CMS) Announces End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model

On September 18, the Centers for Medicare & Medicaid Services (CMS) announced it had “finalized the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model, to improve or maintain the quality of care and reduce Medicare expenditures for patients with chronic kidney disease. The ETC Model delivers on the Executive Order, “Advancing American Kidney Health” and encourages an increased use of home dialysis and kidney transplants to help improve the quality of life of Medicare beneficiaries with ESRD. The ETC Model will impact approximately 30 percent of kidney care providers and will be implemented on January 1, 2021 at an estimated savings of $23 million over five and a half years”.

News in its own right, this announcement gains added importance given that the 21^st Century Cures Act opens the door for previously ineligible ESRD patients to choose to enroll in a Medicare Advantage (MA) Plan starting this fall, with coverage effective on January 1, 2021. CMS expects that 63% of these newly eligible ESRD patients will choose MA coverage by 2026, bringing the need for coordinated, complex care management and an MLR of 112%.

Expanding access to in-home dialysis and kidney transplant is an essential step towards improving ESRD patient's care and costs. However, early identification of those with or at risk for developing kidney disease is critical to slowing kidney disease progression, delaying the onset of ESRD, and avoiding the possibility of crashing into dialysis. Early identification and intervention can "bend the trend" in the number of people living with an ESRD diagnosis, a number that increases by 20,000 each year, as well as the associated cost of caring for them. 

Kidney Health Management (KHM) solutions that use advanced technology, data integration, clinical expertise, and compassionate care will prove successful partners for health plans, providers, and members. This powerful combination can:

• Predict those most at risk for kidney disease and recommend clinically proven interventions that delay disease and slow progression.
• Identify suitable candidates for in-home dialysis and plan for the start of renal replacement therapy
• Support providers by providing data and clinical insights which they can use to improve their understanding of their patient's day-to-day needs, including social determinants of health, medication therapy management, and behavioral assessments, to name a few.
• Empower patients and caregivers with information to make informed decisions impacting their care.
• Telehealth candidates can be identified and assessed for readiness, a vital consideration for kidney care patients who are among the most vulnerable to COVID-19.

Healthmap Solutions is leading the industry with our Kidney Health Management program for health plans managing Medicare Advantage, Commercial, and Medicaid business lines. Please contact us to receive more information on how your health plan and Medicare Advantage plan can benefit from our program.