kidney care models: Kidney Care First (KCF) for nephrology practices and Comprehensive Kidney Care Contracting (CKCC) which offers three distinct payment options. These models will build on the existing Comprehensive ESRD Care (CEC) Model, which began in 2015 and will end in 2020, and incorporate design elements from the recently announced Direct Contracting and Primary Care First models. One of the key lessons learned from the CEC Model was the need to increase coordinated care for beneficiaries with late-stage chronic kidney disease and beneficiaries transitioning onto dialysis. These models will provide strong incentives to better manage and coordinate care for beneficiaries with kidney disease. Model participants will be incentivized through utilization measures and cost incentives to avoid unplanned dialysis starts in the hospital, in an effort to avoid the cost and high mortality that occurs when beneficiaries abruptly start dialysis. Additionally, CMS will also establish measures to demonstrate whether kidney disease is being delayed by the Model’s interventions and develop a quality measure to incentivize better managing beneficiaries with late-stage CKD to avoid the more expensive and burdensome dialysis process. Find more information on the CKC Model at: https://innovation.cms.gov/initiatives/voluntarykidney-models/ ▶ The FDA is developing a new survey to gain insight into patient preferences for new kidney failure treatments. Information collected will be used by FDA and its partners including device developers, patients, providers, payers, and other researchers to inform the development of new treatments, including alternatives to dialysis. The patient preferences survey will be an important example of how patient engagement can contribute to building infrastructure for expanded patient-centered outcomes research and how patient input can be used in FDA’s review processes. Results and methods will also be shared with those involved in data collection efforts for other disease conditions to similarly inform the development of new treatments. ▶ NIH is developing and testing an interoperable open-source electronic care plan tool for people with multiple chronic conditions, including diabetes and kidney disease, to better coordinate their care. In the context of kidney care, this tool will enable patients, physicians, nurses, pharmacists, dieticians, and other health professionals, as well as community health workers, to transfer critical, person-centered kidney care information across multiple settings of care with diverse electronic health record systems using uniform data standards, supporting better coordination of kidney care and research. ▶ Dialysis facilities are currently required to inform patients of their care options. To strengthen patient education and support for patients’ selection of treatment modalities, CMS is considering options for new ways to improve quality of life for dialysis patients while also reducing Medicare costs and minimizing regulatory burden. Page 15 | Advancing American Kidney Health ▶ ASPR is working to ensure people living with kidney failure have access to readily available portable dialysis technologies and access to treatments in any situation. Currently, treatment options are limited following disaster events, and individuals on dialysis must be evacuated and provided temporary housing to continue treatments. Beginning in 2019, ASPR will procure and test portable dialysis units that can provide support to people living with kidney failure in low-resource settings or within their homes, so that they can have access to dialysis with minimal power and from publicly-available water sources, allowing them to return home sooner when a disaster occurs. ▶ CMS supports person-centered optimal starts for individuals living with ESRD. An “optimal start” reflects adequate patient preparation resulting in pre-emptive transplant, initiation of renal replacement with peritoneal dialysis or initiation of hemodialysis with a functioning permanent vascular access. The Innovation Center is announcing the ESRD Treatment Choices (ETC) Model, which will include financial incentives for ESRD facilities and Managing Clinicians selected to participate in the model to better align with beneficiary choice on modalities such as home dialysis or kidney transplants. Find more information on the ETC Model at: https://innovation.cms.gov/initiatives/ esrd-treatment-choices-model/ OBJECTIVE 2. Introduce new value-based kidney disease payment models that align health care provider incentives with patient preferences and improve quality of life As part of HHS’ commitment to transition to payment and delivery models that focus on patient outcomes, preferences, and lowering costs, CMS is introducing a new payment model and has proposed another payment model to encourage more coordinated care to delay kidney failure and ensure that people living with kidney failure have access to the best available care options. Additionally, Medicare will continue to support payment rule changes for the ESRD PPS that focus on patient care, support innovation, reduce burdens, and lower costs. ▶ The Innovation Center’s ETC Model includes financial incentives for ESRD facilities and Managing Clinicians selected to participate in the model to better align with patient choice regarding home dialysis and