Abstract: TH-PO536

A Business Case for New CKD Payment Models

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention


  • Liu, Harry, RAND Corporation, Boston, Massachusetts, United States
  • Zhao, Sophia, Massachusetts General Hospital, Brookline, Massachusetts, United States

Various interventions have been demonstrated to effectively slow down the progression of chronic kidney disease (CKD), smooth the transition to renal replacement therapy (RRT), and improve patient outcomes. Such interventions, however, are rarely adopted due to misaligned incentives in the current healthcare system. This study aims to quantify the savings from CKD interventions and design associated new payment models.


We constructed a simulation model that identifies and quantifies savings opportunities during the CKD progression and transition to RRT, and extracted the model’s parameters from the published literature. Simulation model sensitivity analyses were conducted to account for the uncertainty in input parameters. Assumptions were made only when published data were lacking. New payment models were proposed to materialize such savings opportunities.


The simulation includes the following interventions: increasing the use of pre-dialysis nephrology care to slow down disease progression; smoothing transition to dialysis initiation to decrease the use of inpatient services and increase the adoption of arteriovenous fistula and peritoneal dialysis; and decreasing the use of dialysis among patients with an eGFR of 15 or greater or among patients with advanced age and multiple conditions, for whom the benefits of dialysis is very limited or nonexistent. The simulation model results in an annual savings of $1.0 billion for Medicare [range: $0.5 - $1.8 billion] and $1.8 billion for all payers [range: $0.7 - $2.1 billion]. Increased use of pre-dialysis nephrology care and decreased use of inpatients services at dialysis initiation each contributes to about one third of savings, respectively. The simulation model also suggests that new payment models should focus on Stage 3 and 4 patients and the transition from CKD to RRT. Within Medicare, new payment models can be designed around ESRD Seamless Care Organizations, Special Needs Plans, or Medicare Advantage Plans to streamline incentives and optimize care efficiency. A joint program between Medicare and other payers should be set up so that Medicare and other payers can share savings from CKD interventions.


Tremendous savings opportunities exist in slowing CKD progression and smoothing the transition to RRT, and new payment models should be designed and implemented to reap the benefits.