End Stage Renal Disease (ESRD), a state of kidney failure in which dialysis or kidney transplant is required to sustain life, is among the costliest chronic diseases. Historically, individuals with ESRD have been covered by fee-for-service Medicare after a 30-month waiting period. Spending on individuals with ESRD represents 7 percent of CMS spending.
Beginning in 2021, individuals with ESRD may enroll with or remain on a Medicare Advantage plan, the managed care option for Medicare benefits. The early days of 2021 have been rife with announcements of partnerships between Medicare Advantage plans and dialysis facilities as the largest entities seem to be pairing off to reduce potential financial risk and improve outcomes among new beneficiaries with ESRD. Partnerships between Aetna and Fresenius Medical Care North America, Blue Cross and Blue Shield of Minnesota and DaVita, and Monogram Health and Cigna have been announced. These partnerships seek to optimize ESRD management and upstream prevention.
These deals seem to echo steps Medicare has taken within the fee-for-service program to advance value-based payment models in the ESRD space through the ESRD Quality Incentive Program, ESRD Treatment Choices, and Kidney Care Choices (KCC). Though details of these arrangements have not been publicized, Aetna’s partnership is said to be based on “metrics tied to [CMS] measures to manage ESRD care,” demonstrating alignment towards existing measures and benchmarks.