Medicare Advantage Plan and Chronic Kidney Disease Care Management Company Partnerships After the 21st Century Cures Act.

This article examines how Medicare Advantage (MA) plans responded to the 21st Century Cures Act, which opened MA enrollment to people with end-stage renal disease (ESRD). Through 48 interviews with representatives from MA plans, dialysis provider organizations, and chronic kidney disease (CKD) care management companies, the study found that MA plans formed partnerships with CKD care management companies to manage the care of ESRD patients due to expected increases in enrollment, concerns about costs, and goals to improve care quality and value. These partnerships typically involved risk-based contracts with quality benchmarks, and CKD care management companies employed care coordination strategies such as risk stratification, provider communication, and patient education. Reported benefits included increased use of home dialysis and transplant screening, while challenges involved limited patient access due to the dominance of large dialysis organizations and difficulties forming risk pools for smaller providers. The study highlights the need for further research on patient outcomes, equity of access, and the impact on smaller dialysis providers.