How Legislation Shaped the Value-Based Care Landscape in the U.S.

1. 2010: The Affordable Care Act (ACA) is signed into law, which includes provisions for accountable care organizations (ACOs) and bundled payment models, which are key components of value-based care.

2. 2015: The Medicare Access and CHIP Reauthorization Act (MACRA) is signed into law, which introduces the Quality Payment Program (QPP) and promotes the shift to value-based care by tying Medicare payments to quality and value.

3. 2016: The Comprehensive ESRD Care Model is launched by the Center for Medicare and Medicaid Innovation (CMMI), aiming to improve care for Medicare beneficiaries with end-stage renal disease (ESRD) through a value-based payment model.

• The Comprehensive ESRD Care Model aimed to improve care coordination and quality for Medicare patients with end stage renal disease (ESRD) by implementing a new payment and service delivery model.

• It sought to enhance care coordination between nephrologists, dialysis facilities, and other providers, as well as provide enhanced patient education and support to improve outcomes and reduce costs.

• The model also encouraged the use of home dialysis and kidney transplants as alternative treatment options.

4. 2019: The Advancing American Kidney Health Initiative is announced by the Trump administration, with the goal of transforming kidney care in the United States by promoting a shift towards value-based care and increasing access to kidney transplants and home dialysis.

The Advancing American Kidney Health Initiative included several specific measures, including:

• Increasing access to kidney transplants by providing financial incentives for organ procurement organizations to increase the number of available organs for transplant.

• Promoting the use of home dialysis as a viable alternative to in-center dialysis, with the goal of increasing the number of patients receiving dialysis treatment at home.

• Implementing value-based care models for kidney disease, with an emphasis on preventive care and early intervention to slow the progression of kidney disease.

• Encouraging the development of innovative technologies and treatments for kidney disease, including wearable or implantable artificial kidneys.

• Expanding education and training programs for healthcare professionals to improve the diagnosis and management of kidney disease.

Overall, the initiative aimed to improve the quality of care for individuals with kidney disease, reduce healthcare costs, and ultimately save lives through increased access to transplants and home dialysis to kidney transplants and home dialysis.

5. 2020: The Centers for Medicare and Medicaid Services (CMS) introduces the Kidney Care Choices (KCC) Model, which offers new payment options for nephrology practices to encourage the delivery of high-quality, patient-centered care for patients with chronic kidney disease and ESRD.

• The Kidney Care Choices (KCC) Model provided new payment options for nephrology practices in order to encourage the delivery of high-quality, patient-centered care for patients with chronic kidney disease and end-stage renal disease (ESRD).

• This included incentives for practices to focus on preventive care, care coordination, and patient education, as well as offering alternative payment models to traditional fee-for-service arrangements.

These legislative and programmatic developments have collectively contributed to the current landscape of value-based care in nephrology, with a focus on improving outcomes and reducing costs for patients with kidney disease.