Chronic kidney disease (CKD) is not only a cause of significant morbidity, but also very costly. Patients with CKD often have other chronic conditions, take more medications, and have higher hospitalization rates. When patients reach a point where they need kidney replacement therapy (dialysis), the cost becomes astronomical. It is a strain on Medicare, which covers dialysis for all Americans who need it – at a whopping $50 billion per year. Essentially Medicare is spending 7% of its budget on a disease that affects only 1% of the U.S. population.

Tanya S. Johns, M.D.Faculty ProfileResearch Profile

As a result, the Centers for Medicare & Medicaid Services (CMS) has sought innovative ways to incentivize doctors and dialysis organizations to reduce costs while improving health outcomes. The newest model, and the first Montefiore Einstein has joined, is the Kidney Care Choices (KCC) Model. Its goal is to improve patient outcomes, delay chronic kidney disease progression, expand treatment options, and lower healthcare costs.

Unlike previous models, nephrologists and other kidney care providers and practices are the point of care coordination not the dialysis organizations. Key to the KCC, and how it differs from earlier models, is that it includes patients at earlier stages of kidney disease (stages 4 and 5), not just dialysis patients; provides financial incentives to promote greater use of transplants; includes benefit enhancements to improve skilled nursing facilities, hospice, telehealth, and kidney education services; and directly targets nephrologists’ payments to the meeting of key benchmarks.

Allison B. Stark, M.D.Faculty ProfileResearch Profile

This is the first kidney care entity Montefiore Einstein has joined because it has been at the forefront of coordinated care management since the late 1990s.

We are really building off of a lot of existing infrastructure that the division of nephrology and the department of medicine has developed in concert with Montefiore Einstein’s CMO around comprehensive kidney care, including the kidney care program led by Dr. Tanya Johns and developed with Dr. Carolyn Bauer,” says Allison Stark, M.D., associate professor in the department of Medicine (geriatrics) and in the department of family and social medicine.

Ladan Golestaneh, M.D., M.S.Faculty ProfileResearch Profile

“In that sense it is not new. The KCC is showcasing innovative programs similar to those that Montefiore Einstein’s division of nephrology has been leading in collaboration with the Montefiore CMO.”

“Models like the KCC are holding us accountable for patient outcomes, which is what value-based care is all about,” says Ladan Golestaneh, M.D., professor in the department of medicine (nephrology) and clinical lead for the KCC. “A national quality improvement program that aligns better patient outcomes with cost savings is a benefit to everyone, especially our patient population, who are disproportionately affected by chronic kidney disease.”