KCC (Kidney Care Choices) Model

Background

The current Medicare payment system encourages in-center hemodialysis as the default treatment for patients beginning dialysis. In-center hemodialysis is the most common type of dialysis, and more than 430,000 Medicare Fee-for-Service beneficiaries with ERSD spend an average of 12 hours a week receiving in-center hemodialysis. They suffer from poorer health outcomes, such as higher hospitalization and mortality rates, often the result of underlying disease complications and multiple co-morbidities.

Participants in the KCC Model offer coordinated and seamless care (including dialysis, transplant, and if appropriate, end-of-life care) along with patient education to help empower them to be more active in their care. Patients receive needed services while retaining the freedom to choose providers. KCC builds upon the Comprehensive ESRD Care (CEC) Model — in which dialysis facilities, nephrologists, and other health care providers formed ESRD-focused accountable care organizations— by adding strong financial incentives for health care providers.

Aims

The KCC Model is designed to help health care providers improve the quality of care for people with late-stage chronic kidney disease and ESRD. This model aims to:

• Delay the need for dialysis
• Encourage kidney transplantation
• Help health care providers reduce costs
• Improve the quality of care for patients with late-stage chronic kidney disease and ESRD

Innovation

The KCC Model leverages an ACO approach to provide coordination and support to people with kidney disease. It also promotes education and other information-sharing with patients so they are empowered to actively participate in shared decision-making for their care. This approach can delay disease progression and avoid an unplanned start to in-center hemodialysis treatment, resulting in better health outcomes and lower costs.

Design

The KCC Model has four Options:

Comprehensive Kidney Care Contracting (CKCC) — Graduated, Professional and Global Options: Open to participation by Kidney Contracting Entities (KCEs). KCEs are required to include nephrologists or nephrology practices and transplant providers, while dialysis facilities and other providers and suppliers are optional participants in KCEs.

In the CKCC Graduated, Professional, and Global Options, KCEs receive capitation payments that are similar to the capitation payments under the KCF Option. KCEs take responsibility for the total cost and quality of care for their patients, and in exchange, can receive a portion or all of the Medicare savings they achieve.

The three CKCC Options have distinct accountability frameworks:

• CKCC Graduated Option: This payment arrangement is based on the CEC Model One-Sided Risk Track, allowing certain participants to begin under a lower-reward one-sided model and incrementally phase in to greater risk and greater potential reward.
• CKCC Professional Option: This payment arrangement is based on the Professional option of the Global and Professional Direct Contracting Model, now called ACO REACH, with an opportunity to earn 50% of shared savings or be liable for 50% of shared losses based on the total cost of care for Part A and B services.
• CKCC Global Option: This payment arrangement is based on the Global option of the Global and Professional Direct Contracting Model, now called ACO REACH, with risk for 100% of the total cost of care for all Parts A and B services for aligned beneficiaries.

CMS Kidney Care First (KCF) Option: Open to participation by nephrology practices and their nephrologists and nephrology professionals though the end of 2025, and subject to meeting certain eligibility requirements.

Participating nephrology practices and their nephrologists and nephrology professionals only receive adjusted capitation payments for managing care of aligned beneficiaries with CKD Stage 4 or 5, and for those on dialysis. These payments are adjusted based on health outcomes and utilization compared to both the participants’ own experience and national standards, and also performance on quality measures. In addition, KCF Practices receive a bonus payment for every aligned beneficiary who receives a kidney transplant, with the full amount of the bonus paid over three years following the transplant, provided the transplant remains successful.

The first cohort of KCC Model participants began their performance period on January 1, 2022. A second cohort began on January 1, 2023. CMS does not plan to conduct any further solicitations for KCC Model participants.

Beneficiaries treated through the KCC Model either have:

• Chronic kidney disease stages 4 and 5
• ESRD and receive maintenance dialysis
• Aligned to a KCF practice or KCE by having chronic kidney disease Stage 4 or 5 or ESRD and received dialysis, and then receive a kidney transplant

Alignment takes into consideration where a beneficiary receives the majority of their kidney care. When an aligned beneficiary receives a kidney transplant, they remain aligned to the model participant for three years following a successful kidney transplant or until the time a kidney transplant fails, at which point the beneficiary could be re-aligned if they meet the requirements for alignment by virtue of their ESRD.

Participant Resources

• PY 2024 Participant and Affiliation List
• Participation Fast Facts

KCC has been extended through 2027 and additional changes will go into effect in 2026 to improve the model test sustainability, including adjusting the financial methodology and participation options. For more information, see KCC Model Performance Year 2026 Updates.

Under the direction of CMS, the ESRD Network Program consists of a national network of 18 ESRD Networks, responsible for each U.S. state, territory, and the District of Columbia. ESRD Networks service geographic areas based on the number and concentration of ESRD beneficiaries.

• ESRD National Coordinating Center Network Map

Model Participation Overviews

• PY2025
• PY2024 (Updated)
• PY2023
• PY2022

Visit the KCC Model Archived Materials Page for more information on model participation, past events, and other materials from previous performance years.

Latest Evaluation Report

The KCC Model increased Optimal ESRD Starts, rates of homes dialysis, and preemptive and living donor transplants. Despite these gains, the model resulted in statistically significant net losses of approximately $304 million to Medicare in performance year (PY) 2023.

• Kidney Care Choices Model - Summary of Findings for the Second Performance Year, 2023

Prior Evaluation Reports

Home dialysis in KCF option and home dialysis training in CKCC option increased, and Optimal ESRD Starts increased in the CKCC option, although most other quality measures were unchanged. There was no evidence of impacts on overall Medicare payments, net savings or losses to Medicare, or unintended consequences.

First Annual Evaluation

• At-A-Glance
• Executive Summary
• Report
• Appendices

For additional evaluation reports, visit the CMS Innovation Center Evaluations & Research Reports webpage.

•  Performance Year 2026 Model Update – Quick Reference
• Fact Sheet (PDF)
• Model Participation Fast Facts (PDF)
• Availability of the CMS-Sponsored Models Safe Harbor (PDF)
• Kidney Care First (KCF) Option FAQs (PDF)
• Comprehensive Kidney Care Contracting (CKCC) Option FAQs (PDF)
• The Medicare CEC Model: Using Lessons Learned To Improve Value-Based Kidney Care
• KCC Archived Materials