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Arbor Research, in collaboration with the Kidney Epidemiology and Cost Center at the University of Michigan (KECC), conducts several related studies for the Centers for Medicare and Medicaid Services (CMS) on disease management and end-stage renal disease (ESRD).

ESRD Disease Management Demonstration Evaluation

The Disease Management Evaluation Demonstration is designed to test the effectiveness of disease management (DM) models to increase quality of care for ESRD patients while ensuring that this care is provided effectively and efficiently.

This project evaluates opportunities for Medicare patients to join integrated care management systems. It focuses on the disease management program structure, processes of care, provider acceptance, costs, and patient outcomes including hospitalization, mortality, satisfaction and quality of life.

The ESRD Disease Management Demonstration, which is being evaluated by Arbor Research, features two distinct payment models: a capitation payment system and a fee-for-service system. The awardees may include dialysis providers, disease management organizations, managed care plan providers, and integrated health systems. The evaluation of the demonstration will be lead by Arbor Research in collaboration with researchers from the National Opinion Research Center (NORC), the Lewin Group, and the University of Michigan. The demonstration, which began in 2004, is expected to last four years.

Analyzing Quality Incentive Payments (QIP) for CMS

Arbor Research, in conjunction with KECC, administers for CMS the project, “Implementation Support for the Quality Incentive Payment of the ESRD Disease Management Demonstration, Implementation and Support for an Advisory Board for the ESRD Bundled Case-Mix Adjusted Demonstration.” The project involves collaboration on two important end-stage renal disease (ESRD) demonstrations that aim to improve the quality of care for kidney dialysis patients:

• Calculating the quality incentive payment for the ESRD Disease Management Demonstration (for which Arbor Research is the primary contractor)
• Implementing and supporting an advisory board for the ESRD Bundled Case-Mix Adjusted Demonstration, including research on payment methodology, clinical factors, and other issues as they pertain to a bundled case-mix adjusted payment system for ESRD

The Arbor Research-led team, with multidisciplinary experts from KECC, brings extensive professional and organizational capability to bear on this project, which began in October 2004 and provides ongoing support for the two CMS demonstrations. Under the leadership of Drs. Port, Hirth, and Wolfe, the project involves cost analysis using both primary and secondary data sources, formulating the methodology/analysis plan for the incentive payment and bundled case-mix adjusted payments, and analyzing ESRD data.

CMS Advisory Board on the Demonstration of a Bundled Case-Mix Adjusted Payment System for ESRD Services

The Medicare Modernization Act of 2003 (MMA §623e) requires “a demonstration project of the use of a fully case-mix adjusted payment system for end stage renal disease services” which include:

• “drugs and biologicals (including erythropoietin) furnished to end stage renal disease patients under the Medicare program which are separately billed by end stage renal disease facilities…” and
• “clinical laboratory tests related to such drugs and biologicals.”

Arbor Research and KECC contracted by CMS to support the deliberations of the Advisory Board and the implementation of this demonstration. The demonstration, which is being conducted over a three-year period, includes several types of dialysis facilities (e.g., by rural/urban, for-profit status, independent, small, pediatric).

Participants will receive 1.6% increase in composite rate payments, and an Advisory Board is being established to make recommendations regarding design and implementation of the demonstration.

For information about the various ESRD Disease Management projects for CMS, please contact: