The Center for Chronic Disease Research and Policy is proud to feature a keynote lecture by Tom Duvall, “The Medicare CEC Model: Using Lessons Learned To Improve Value-Based Kidney Care” at our 12th Annual Symposium: Intersections of Policy, Innovation, Healthcare, and Financialization for Kidney Disease: Where Are We in America Today? on October 16, 2024. REGISTER HERE.
Tom Duvall is the Division Director for the Division of Special Populations and Projects in the Seamless Care Models Group at the CMS Innovation Center. In that role, he oversees three payment model tests focused on improving care for beneficiaries with kidney disease, which are the ETC, KCC, and IOTA Models, and two payment models focused on rural hospitals. He has worked with CMMI for over ten years and previously worked in Medicaid Policy and Financial Consulting for Mercer Consulting. He received his undergraduate degree from the University of Michigan and his Health Care MBA from Johns Hopkins University.
How did you become interested in kidneys and chronic kidney disease?
I joined Centers for Medicare and Medicaid Services (CMS) in 2014 and was initially working on some other models at [the Center for Medicare and Medicaid Innovation (CMMI)]. There, I began working on the finance workstream for the [Comprehensive ESRD Care (CEC) Model, which was designed to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease (ESRD)] and transitioned into the role of team lead. We developed the two successor models, the Kidney Care Choices Model (KCC) and the ESRD Treatment Choices (ETC) Model. Now we’re on our third-generation kidney models.
What do you think are the greatest problems in kidney health today?
Kidney disease patients are very complicated and have a lot of different types of needs. It’s a challenge to get the doctors and dialysis facilities to focus on the whole beneficiary’s needs. The existing payment system and the existing care patterns get patients in a pattern that gets them through in-center dialysis. The main focus has been in-center dialysis as opposed to thinking in some more potentially patient- centered ways, like home dialysis, transplants, and other things that that could ultimately be a better option for patients on their lifestyle.
What interests you the most about studying chronic kidney disease?
Kidney disease contains all the problems of the American healthcare system, just more intensely, in that you have some very sick patients who are high utilizers, you have a lot of issues around social determinants of health with these patients, you have a unique marketplace of providers. Medicare has a special role to play, given the special eligibility for kidney disease patients to get on Medicare. It’s good to help make care better at Medicare and help to make care better for patients.
Could you share a little bit about your upcoming talk?
I will be speaking about the CEC model and about the evolution of our thinking around payment models within CMMI. Everything we have done builds on the CEC model, a Medicare payment model that ran from 2015 to 2021 that was based around dialysis facilities working with other providers to take accountability for the cost and quality of care for their patients. In the CMS Innovation Center, we run different payment demonstrations in an effort to test out different models of care to see what can result in better outcomes for beneficiaries and lower cost for the government. The CEC model showed a statistically significant reduction in hospitalizations, which we’re pretty proud of um, a better vascular access, a decrease in catheters, and an increase in patient experience of care, so I think it had some good quality results. We then created a successor model that we’re operating right now called the Kidney Care Choices Model that that builds on the lessons we learned. It’s centered around nephrologists taking accountability rather than dialysis facilities. It includes more upstream and downstream care, so it includes a focus on CKD as well as transplant care, expanding into late stage CKD. It includes some direct payment adjustments for nephrologists to help better align payments with patient goals.
What are you looking forward to at the CDRP symposium this year?
I’m interested to hear from folks in the field, especially when looking at kidney disease within the larger realm of chronic disease. It will also be interesting to trace the whole journey of these kidney models and efforts to where we’ve been and to help figure out where we’re going.