4 The QUEE NS Courier • wellnes • october 22, 2015 for breaking news visit www.qns.com wellness s New Medicare program targets patients on dialysis FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES More than 600,000 Americans have end-stage renal disease (ESRD), also known as kidney failure, and require life sustaining dialysis treatments several times per week. These individuals typically have many health problems, are at higher risk of hospital readmissions, and suffer from fragmented care. In 2012, ESRD beneficiaries comprised 1.1 percent of the Medicare population and accounted for an estimated 5.6 percent of total Medicare spending. As part of the Department of Health and Human Services’ approach to building a health care delivery system that results in better care while using taxpayer dollars more wisely, the Centers for Medicare & Medicaid Services (CMS) has announced the participants for the Comprehensive ESRD Care (CEC) Model a new accountable care organization (ACO) model made possible by the Affordable Care Act and conducted by the CMS Innovation Center. The ACOs are groups of physicians and other health care providers who collectively take on responsibility for the quality and cost of care for a population of patients. The CEC Model is designed specifically for beneficiaries with ESRD and builds on experiences from other models and programs with ACOs, including the Pioneer ACO Model and the Medicare Shared Savings Program. In the CEC Model, dialysis facilities, nephrologists, and other providers have joined together to form ESRD Seamless Care Organizations (ESCOs) to coordinate care for ESRD beneficiaries. ESCOs will be financially accountable for quality outcomes and Medicare Part A and B spending, including all spending for dialysis services, for their ESRD beneficiaries. This model will encourage dialysis providers to think beyond their traditional roles in care delivery and support beneficiaries as they provide patientcentered care that will address beneficiaries’ health needs in and out of the dialysis facility. “This new ACO model represents a paradigm shift in care for beneficiaries with end-stage renal disease; it promotes a patient-centered approach to their dialysis and non-dialysis care needs that will help accomplish our delivery system reform goals of better care, smarter spending, and healthier people,” said Patrick Conway, M.D., MSc, acting deputy administrator and chief medical officer, CMS. The CEC Model includes separate financial arrangements for ESCOs with large and small dialysis organizations. ESCOs with participation by a dialysis facility or facilities owned by a large dialysis organization, which is an organization that owns 200 or more dialysis facilities, will be eligible to receive shared savings payments, but will also be liable for shared losses, and will have higher overall levels of risk compared with their smaller counterparts. ESCOs with participation by a dialysis facility or facilities owned by a small dialysis organization, which is an organization that owns fewer than 200 dialysis facilities, will be eligible to receive shared savings payments, but will not be liable for shared losses. The CEC Model is part of the department’s efforts to create opportunities for providers to enter into alternative payment models and meet the Secretary’s goal, announced on Jan. 26, to have 30 percent of traditional Medicare payments paid through alternative payment models by the end of 2016 and 50 percent by the end of 2018. CMS issued an open call for applications for the CEC Model in April 2014. The Rogosin Kidney Care Alliance is the ESCO for New York. For more information on the CEC Model, visit http://innovation.cms.gov/initiatives/comprehensive esrd-care/. INCREASE YOUR HEALTH BENEFITS, NOT YOUR COSTS The Healthfirst Increased Benefits Plan (HMO) With this Medicare Advantage plan, you could pay as little as $0 for better benefits than Medicare—if you currently receive Extra Help. Call to enroll or set up an in-person meeting! 1-855-725-3341 (TTY 1-888-542-3821) 7 days a week, 8am-8pm. Visit www.YourHFIBP.org Managed Health, Inc., dba Healthfirst Medicare Plan, offers HMO plans that contract with the Federal Government. Enrollment in Healthfirst Medicare Plan depends on contract renewal. The benefit information provided is a brief summary, not a complete description, of benefits. Limitations, copayments, and restrictions may apply. Benefits may change on January 1 of each year. Premiums, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. This information is available for free in other languages. Please call our Member Services number at 1-888-260-1010, TTY number 1-888-542-3821, 7 days a week, from 8am to 8pm. Esta información está disponible en forma gratuita en otros idiomas. Por favor, comuníquese con nuestro número de Servicios a los Miembros al 1-888-260-1010, o al 1-888-867-4132 para los usuarios de TTY, los 7 días de la semana, de 8:00 a.m. a 8:00 p.m. © 2015 HF Management Services, LLC. NYMED00939 H3359_MKT16_32 Accepted 09202015
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