Abstract: FR-PO0019
Effectiveness of the Comprehensive Kidney Care Contracting (CKCC) Model on Kidney Treatment Outcomes and Medicare Expenditures
Session Information
- Artificial Intelligence: Clinical Prediction, Decision Support, and Digital Kidney Care
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Artificial Intelligence, Digital Health, and Data Science
- 300 Artificial Intelligence, Digital Health, and Data Science
Author
- Tripathi, Ohm S., University of Connecticut, Storrs, Connecticut, United States
Background
To determine whether participation in the Comprehensive Kidney Care Contracting (CKCC) Model was independently associated with differential improvement in kidney care quality and Medicare expenditures during its first two years.
Methods
Retrospective cohort study of Medicare fee-for-service beneficiaries in CKCC practices versus geographically matched non-CKCC comparators across 8 quarters (Q1 2022–Q4 2023). Nine outcomes were analyzed in 2 populations—chronic kidney disease (CKD) stage 4-5 and dialysis-dependent end-stage renal disease (ESRD)—including incident and prevalent home dialysis, permanent vascular access at hemodialysis initiation, optimal ESRD start, outpatient dialysis initiation, kidney transplant rates, and per-person-per-year Medicare costs. Analyses employed difference-in-differences (DiD) regression, within-group interrupted time series, independent-samples t-tests, and Wilcoxon signed-rank tests.
Results
DiD regression identified a statistically significant differential quarterly improvement in permanent vascular access at hemodialysis initiation favoring CKCC practices (β = +1.44 percentage points/quarter; 95% CI, 0.24-2.65; P = .023). Within-group trend analysis demonstrated a significant upward trajectory in preemptive kidney transplantation exclusively among CKCC-aligned CKD beneficiaries (+0.021 per 100 person-years/quarter; P = .014), absent in comparators (P = .318). CKCC-aligned beneficiaries showed consistently superior outcomes across all quality metrics (Cohen d = 2.89-5.75; Wilcoxon P ≤ .047) and lower costs for CKD stage 4-5 beneficiaries (mean difference, −$3876/year; P < .001).
Conclusion
CKCC participation was associated with significant differential improvements in vascular access quality and preemptive transplantation alongside lower Medicare expenditures. These findings support extending voluntary, risk-bearing kidney care payment models and identify permanent vascular access planning as a priority for broader dissemination.