DPC is a strong advocate of Value-Based Care. Value-Based Care means that your primary providers accept a single payment or budgeted amount to cover all your medical needs. For instance, if you are in a program like Comprehensive Kidney Care Contracting (or CKCC, formerly known as the ESCO program) your dialysis provider and nephrologist take responsibility for all your care—not just kidney care but other conditions, such as diabetes, and other sites of care, such as hospitals. There are currently three types of value-based care programs that kidney patients may be in:
- Comprehensive Kidney Care Contracting (CKCC) – you are assigned based on your dialysis clinic or nephrologist.
- Accountable Care Organizations (ACOs) – you are usually assigned based on your primary care physician.
- Medicare Advantage – you enroll in a health plan, which contracts with your providers.
With CKCC and ACOs, you remain in Original Medicare and can continue to see any provider. You are not limited to specialty care for which your doctor refers you. In contrast, Medicare Advantage is a managed care program and you may need referrals or prior authorization for certain care.
Comprehensive Kidney Care Contracting and Accountable Care Organizations are programs to which Medicare beneficiaries are assigned, based on whether their dialysis clinic or nephrologist participate in CKCC, or their primary care doctor participate in an ACO. These programs are not available everywhere. Unlike Medicare Advantage, you cannot enroll in these programs.
If you have been assigned to a Comprehensive Kidney Care Contracting program or Accountable Care Organization you will be informed by mail. The letter will tell you that your Medicare claims data will be shared with the CKCC program or ACO. The purpose of sharing your medical claims is to let your care team know about your comorbidities, because they will take responsibility for managing them; and to let them know about your hospitalizations, because the primary aim of these programs is to prevent complications that cause unplanned hospital stays.
If you are in a Comprehensive Kidney Care Contracting program, you will be asked to complete a comprehensive health evaluation by a Nurse Practitioner. If you are in an Accountable Care Organization, you will be invited for an Annual Wellness Visit. These visits review all of your health conditions so that care coordinators can help you manage them.
Value-Based Care has two purposes. Medicare has set up the CKCC and ACO programs to reduce costs by making doctors deliver care within a budget. But the budget also incentivizes your doctors to better coordinate and streamline your care. This is because they can keep the savings when they prevent complications, reduce duplicative tests, or avoid treatment that is unnecessary or of uncertain value. Value-based care also gives doctors flexibility to deliver services that can’t be billed in Original Medicare, such as answering your phone calls, hiring nurse practitioners or lay health workers to stay in touch with you, delivering meals, or other non-medical interventions likely to keep you stable.
Value-Based Care does not take away your freedom of choice in Original Medicare. It should improve the care you receive for chronic diseases. But doctors are incentivized to recommend less expensive care if you face a very costly illness such as cancer. If you get a feeling that your doctor is not discussing all of your potential treatment options with you, you may seek a second opinion from any other provider who participates in Medicare, and obtain care recommended by any doctor who treats you.
