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.

CEC Model Static Map - Click to learn more

There were 33 ESRD Seamless Care Organizations (ESCOs) participating in the Comprehensive ESRD Care Model.


Large Dialysis Organizations (LDOs):

Participating Dialysis Provider OrganizationESCO NameLocation
Dialysis Clinic Inc. (DCI)Music City Kidney Care Alliance, LLCNashville, TN
Dialysis Clinic Inc. (DCI)Metropolitan Kidney Care Alliance, LLCNewark, NJ
Dialysis Clinic Inc. (DCI)Independence Kidney Care Alliance, LLCPittsburgh, PA
FreseniusFresenius Seamless Care of Philadelphia, LLCPhiladelphia, PA
FreseniusFresenius Seamless Care of San Diego, LLCSan Diego, CA
FreseniusFresenius Seamless Care of ChicagoChicago, IL
FreseniusFresenius Seamless Care of ColumbiaColumbia, SC
FreseniusFresenius Seamless Care of Dallas, LLCDallas, TX
FreseniusFresenius Seamless Care of Charlotte, LLCCharlotte, NC
FreseniusFresenius Seamless Care of LouisianaBaton Rouge, LA
FreseniusFresenius Seamless Care of IndianapolisIndianapolis, IN
FreseniusFresenius Seamless Care of MinneapolisMinneapolis, MN
FreseniusFresenius Seamless Care of PortlandPortland, OR
FreseniusFresenius Seamless Care of MichiganDetroit, MI
FreseniusFresenius Seamless Care of AtlantaAtlanta, GA
FreseniusFresenius Seamless Care of MassachusettsBoston, MA
FreseniusFresenius Seamless Care of HoustonHouston, TX
FreseniusFresenius Seamless Care of Central AlabamaBirmingham, AL
FreseniusFresenius Seamless Care of Gulf ShoreMobile, AL
FreseniusFresenius Seamless Care of Las VegasLas Vegas, NV
FreseniusFresenius Seamless Care of Erie ValleyPittsburgh, PA
FreseniusFresenius Seamless Care of New YorkNew York, NY
FreseniusFresenius Seamless Care of MarylandBethesda, MD
FreseniusFresenius Seamless Care of Central North CarolinaRaleigh, NC
FreseniusFresenius Seamless Care of DelawareWilmington, DE
FreseniusFresenius Seamless Care of Central IllinoisPeoria, IL
DaVitaPhoenix-Tucson integrated Kidney CarePhoenix, AZ
DaVitaSouth Florida Integrated Kidney CareMiami, FL
DaVitaPhiladelphia-Camden Integrated Kidney CarePhiladelphia, PA

Non-Large Dialysis Organizations (Non-LDOs):

CompanyESCO NameLocation
RogosinRogosin Kidney Care Alliance, LLCNew York, NY
Centers for Dialysis Care (CDC)Northeast Ohio Renal Alliance, LLCCleveland, OH
Atlantic DialysisThe Gotham City Kidney Care ESCO, LLCNew York, NY
Northwest Kidney CentersNorthwest Kidney Care AllianceSeattle, 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.


Latest Evaluation Report

Prior Evaluation Reports

Financial and Quality Results

Learning System Case Studies

Additional Research 

Additional Information

General Information



Tip Sheet

Questions about the Comprehensive ESRD Care Model can be sent to

Where Health Care Innovation is Happening