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.
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):
|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.
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.
Stay up to date on the latest CEC Model updates by subscribing to the CEC Model listserv.
Latest Evaluation Report
- Two Pager: At-A-Glance Report (PDF)
Prior Evaluation Reports
- Two Pager: CEC Annual Evaluation Report - Performance Year 5 Findings-At-A-Glance Report (PDF)
- Two Pager: CEC Annual Evaluation Report - Performance Year 4 Findings-At-A-Glance Report (PDF)
- Two Pager: CEC Annual Evaluation Report - Performance Year 3 Findings-At-A-Glance Report (PDF)
- Two Pager: CEC Annual Evaluation Performance Year 2 Findings-At-A-Glance Report (PDF)
- CEC Annual Evaluation Report - Performance Year 1 (2015 - 2016) (PDF)
Financial and Quality Results
- CEC Financial and Quality Results Performance Year 5 (2020) (XLS)
- CEC Financial and Quality Results Performance Year 4 (2019) (XLS)
- CEC Financial and Quality Results Performance Year 3 (2018) (XLS)
- CEC Financial and Quality Results Performance Year 2 (2017) (XLS)
- CEC Financial and Quality Results Performance Year 1 (2015 - 2016) (PDF)
Learning System Case Studies
- Fresenius Kidney Care's Home Dialysis Program (PDF) (January 2021)
- Atlantic Dialysis Management Services' Patient Navigator Program (PDF) (February 2020)
- Center's for Dialysis Care's Patient Advisory Committees (PDF) (February 2020)
- Rogosin Institute's Initiative to Promote Health Literacy (PDF)
- Fact Sheet (PDF)
- Attribution Fact Sheet (PDF)
- Press Release
- Frequently Asked Questions (PDF)
- CEC Performance Year 2 Request for Applications (PDF)
- Fact Sheet: Comprehensive ESRD Care Model
- CEC Quality Performance LDO (PDF)
- CEC Quality Performance Non-LDO (PDF)
- CEC 2018 Quality Measure Set and Weights (PDF)
- CEC 2019 Quality Measure Set and Weights (PDF)
- Archived Materials
- Webinar: Updates to the Innovation Center Kidney Models (March 2, 2022) - Transcript (PDF) | Slides (PDF) | Recording (MP4)
- Beneficiary Engagement Toolkit (PDF)
- Care Coordination Toolkit (PDF)
- Provider Engagement Toolkit (PDF)
- Care Transformation Toolkit (PDF) (January 2021)
Questions about the Comprehensive ESRD Care Model can be sent to ESRD-CMMI@cms.hhs.gov.