In our previous pieces, we discussed lessons learned from primary care’s shift to full risk and outlined how these models work in Medicare Advantage (MA). So, how can you prepare your nephrology practice for this new opportunity?
Let’s walk through payor expectations, keys to success and the roadmap for readying your practice for nephrologist-centered full-risk models.
While MA full-risk contracts share many similarities with other value-based care (VBC) models familiar to the nephrology space — like the Comprehensive Kidney Care Contracting (CKCC) model — they are much more resource-intensive and complex.
The risk dollars (including the financial upside) and the bar for performance are often much higher for MA than other models. Therefore, payors shifting risk on chronic kidney disease (CKD) and end-stage kidney disease (ESKD) MA patients are looking for partners with a demonstrated commitment to risk models, significant capital to invest (and cover risk) and specialized capabilities to successfully participate in these models.
As you think about participating in these models, there are a few key questions you should ask your practice:
Practices taking on full risk need to be equipped to manage their patients’ full continuum of care — not just kidney care services. Taking this holistic approach to patient care requires specialized capabilities. For practices already participating in CKCC, these requirements may seem familiar. However, full risk goes a few steps beyond the infrastructural needs for CKCC participation.
First movers into these full-risk models have the unique opportunity to access significant improvements in patient care, innovative care delivery resources, and increased practice revenue. While nephrologists are increasingly evolving their infrastructure to more successfully adopt VBC contracts, there is still much to be done to prepare to commit to full-risk models. Nephrology groups should ensure the proper due diligence is done before deciding to participate in full risk. Here’s how:
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