Comprehensive ESRD Care Model

The Comprehensive ESRD Care (CEC) Model was 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 partnered 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. The Model built on Accountable Care Organization experience from the Pioneer ACO Model, Next Generation ACO Model, and the Medicare Shared Savings Program to test Accountable Care Organizations for ESRD beneficiaries.

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CEC Model Static Map - Click to learn more

There were 33 ESRD Seamless Care Organizations (ESCOs) participating in the Comprehensive ESRD Care Model. To view an interactive map of this Model, visit the Where Innovation is Happening page, and select this model from the drop-down menu on the left side of the page.

Large Dialysis Organizations (LDOs):

Participating Dialysis Provider Organization ESCO Name Location
Dialysis Clinic Inc. (DCI) Music City Kidney Care Alliance, LLC Nashville, TN
Dialysis Clinic Inc. (DCI) Metropolitan Kidney Care Alliance, LLC Newark, NJ
Dialysis Clinic Inc. (DCI) Independence Kidney Care Alliance, LLC Pittsburgh, PA
Fresenius Fresenius Seamless Care of Philadelphia, LLC Philadelphia, PA
Fresenius Fresenius Seamless Care of San Diego, LLC San Diego, CA
Fresenius Fresenius Seamless Care of Chicago Chicago, IL
Fresenius Fresenius Seamless Care of Columbia Columbia, SC
Fresenius Fresenius Seamless Care of Dallas, LLC Dallas, TX
Fresenius Fresenius Seamless Care of Charlotte, LLC Charlotte, NC
Fresenius Fresenius Seamless Care of Louisiana Baton Rouge, LA
Fresenius Fresenius Seamless Care of Indianapolis Indianapolis, IN
Fresenius Fresenius Seamless Care of Minneapolis Minneapolis, MN
Fresenius Fresenius Seamless Care of Portland Portland, OR
Fresenius Fresenius Seamless Care of Michigan Detroit, MI
Fresenius Fresenius Seamless Care of Atlanta Atlanta, GA
Fresenius Fresenius Seamless Care of Massachusetts Boston, MA
Fresenius Fresenius Seamless Care of Houston Houston, TX
Fresenius Fresenius Seamless Care of Central Alabama Birmingham, AL
Fresenius Fresenius Seamless Care of Gulf Shore Mobile, AL
Fresenius Fresenius Seamless Care of Las Vegas Las Vegas, NV
Fresenius Fresenius Seamless Care of Erie Valley Pittsburgh, PA
Fresenius Fresenius Seamless Care of New York New York, NY
Fresenius Fresenius Seamless Care of Maryland Bethesda, MD
Fresenius Fresenius Seamless Care of Central North Carolina Raleigh, NC
Fresenius Fresenius Seamless Care of Delaware Wilmington, DE
Fresenius Fresenius Seamless Care of Central Illinois Peoria, IL
DaVita Phoenix-Tucson integrated Kidney Care Phoenix, AZ
DaVita South Florida Integrated Kidney Care Miami, FL
DaVita Philadelphia-Camden Integrated Kidney Care Philadelphia, PA


Non-Large Dialysis Organizations (Non-LDOs):

Company ESCO Name Location
Rogosin Rogosin Kidney Care Alliance, LLC New York, NY
Centers for Dialysis Care (CDC) Northeast Ohio Renal Alliance, LLC Cleveland, OH
Atlantic Dialysis The Gotham City Kidney Care ESCO, LLC New York, NY
Northwest Kidney Centers Northwest Kidney Care Alliance Seattle, WA

More than 700,000 Americans have ESRD and require life sustaining dialysis treatments several times per week. Many beneficiaries with ESRD suffer from poorer health outcomes, often the result of underlying disease complications and multiple co-morbidities. These can lead to high rates of hospital admission and readmissions, as well as a mortality rate that is higher than that of the general Medicare population. 

According to the United States Renal Data System, in 2016 ESRD beneficiaries comprised less than 1% of the Medicare population, but accounted for an estimated 7.2% of total Medicare fee-for-service spending, totaling over $35.4 billion. Because of their complex health needs, beneficiaries often require visits to multiple providers and follow multiple care plans, all of which can be challenging for beneficiaries if care is not coordinated. The CEC Model sought to create incentives to enhance care coordination and to create a person-centered, coordinated, care experience, and to ultimately improve health outcomes for this population.

Model Details

In the CEC Model, dialysis clinics, nephrologists and other providers joined together to create an ESCO to coordinate care for matched beneficiaries. ESCOs are accountable for clinical quality outcomes and financial outcomes measured by Medicare Part A and B spending, including all spending on dialysis services for their aligned ESRD beneficiaries. The model encouraged dialysis providers to think beyond their traditional roles in care delivery and supported them as they provided patient-centered care that addressed beneficiaries’ health needs, both in and outside of the dialysis clinic.

The CEC Model included separate financial arrangements for larger and smaller dialysis organizations. Large Dialysis Organizations (LDOs), which had 200 or more dialysis facilities, were eligible to receive shared savings payments. These large dialysis organizations were liable for shared losses, and had higher overall levels of risk compared with their smaller counterparts.

Non-large dialysis organizations (Non-LDOs) included chains with fewer than 200 dialysis facilities, independent dialysis facilities, and hospital-based dialysis facilities. Non-LDOs will had the option of participating in a one-sided track where they were able to receive shared savings payments, but were not liable for payment of shared losses, or participating in a track with higher risk and the potential for shared losses. The one-sided track was offered in recognition of non-LDOs more limited resources.

The CEC Model began October 2015 and ended March 31, 2021. The CEC Model conducted a solicitation in 2016 to add more ESCOs, that started in PY 2 of the model on January 1, 2017. There are no plans for another round of solicitation. However, the Kidney Care Choices (KCC) Model builds upon the CEC Model structure by adding strong financial incentives for health care providers to manage the care for Medicare beneficiaries with chronic kidney disease (CKD) stages 4 and 5 and ESRD, to delay the onset of dialysis and to incentivize kidney transplantation.

The CEC Model LDO payment track and Non-LDO two-sided payment track were considered Advanced APMs for the purpose of the Quality Payment Program. For more information on APMs, please visit the Quality Payment Program website.

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