A coalition of provider organizations focused on kidney care is calling on the Center for Medicare & Medicaid Innovation (CMMI) to create a long-term, stable accountable kidney care model. The current demonstration model, Comprehensive Kidney Care Contracting (CKCC), is slated to end in 2027.

Accountable for Health is an advocacy organization of more than 60 providers, payers, and innovators founded to champion accountable care. Its Kidney Care Coalition, representing more than 95% of participants in CMMI’s kidney-focused models, is making the case for continued support of specialty-focused accountable care models for Medicare beneficiaries with chronic kidney disease (CKD) and End-Stage Renal Disease (ESRD).
 
In one paper, the coalition argues that the CKCC model shows stronger savings potential than early evaluations suggest while delivering significant quality improvements. It calls on CMS to ensure long-term stability for patients and doctors participating in accountable kidney care.

The coalition notes that the CKCC model has already demonstrated meaningful gains in patient care. An independent CMS evaluation found a 31% improvement in optimal dialysis starts, a 10% increase in home dialysis, and a 69% increase in pre-emptive transplants. These improvements in patient care and quality outcomes will continue to grow over time. 

A second paper lays out a policy roadmap for stabilizing accountable kidney care beyond 2027. The recommendations call on CMS to ensure there is no gap for beneficiaries once the current model sunsets at the end of next year.

The paper notes that CMMI could achieve that “no gap” goal either by creating an extension of the current model or developing a kidney-specific track within LEAD.

“Medicare beneficiaries with kidney disease are among the most medically complex and costly patients in the program, and they deserve care models designed around their needs,” said Mara McDermott, CEO of Accountable for Health, in a statement. “The early evidence shows that accountable kidney care is improving quality, and today’s independent analysis shows that the model’s financial story is stronger than headline evaluation results suggest. CMS should continue to build on this important progress.”
 
A4H’s Kidney Care Coalition recommends that CMS take several steps to stabilize accountable kidney care, including:
• Reassess early model performance results using the updated 2026 program design features;
• Expanding beneficiary alignment to support earlier intervention for patients with CKD;
• Improving participation rules so more nephrologists and patients can access the model;
• Using risk adjustment and benchmarks that reflect the clinical complexity of kidney disease;
• Preserving incentives for organizations that have already generated savings; and
• Refining quality measures to focus on meaningful, measurable, and actionable outcomes.
 
A4H is urging CMS to work with kidney care leaders on a successor pathway that ensures access to a stabilized, predictable accountable kidney care model.
 
“Ending CKCC without a clear next step would risk undoing years of provider investment and disrupting care for some of Medicare’s highest-need beneficiaries,” said David Pollack, president and chief operating officer at Interwell Health, in a statement. “CMS has an opportunity to preserve momentum, strengthen the model, and give patients with kidney disease continued access to coordinated, accountable care.”

Interwell supports nephrology practices in the CKCC with resources including embedded renal care coordinators, clinical documentation support, and advanced analytics. As the largest participant in the CKCC program option, Interwell has delivered $273 million in shared savings.