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Primary care involvement in End Stage Renal Disease Seamless Care Organizations (ESCOs) and the quality and costs of care for patients on chronic dialysis

Award Number: R01HS026908
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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PROJECT SUMMARY End-stage renal disease (ESRD) patients on chronic dialysis are extremely costly to manage, accounting for 7% of Medicare spending, yet representing 1% of the population. Most of their costs stem from management of the multiple and severe comorbidities that are highly prevalent in this group, with mortality rates 20-fold higher than patients of similar age and sex in the general population. To address these issues, Medicare established in 2015 a model of specialty-oriented accountable care organizations (ACOs), known as ESRD Seamless Care Organizations (ESCOs). Constituted by dialysis centers and nephrologists, ESCOs accept responsibility for costs and quality of care of aligned beneficiaries in exchange for potential shared savings. A report on the first performance year demonstrated $75 million in savings. With promising results to date, the program is being rapidly expanded. However, much remains unclear about how these savings were achieved and what impact they will have on clinical outcomes. Not all the ESCOs achieved savings, and there was over six-fold variation in savings per beneficiary across those that did. There was also substantial variability in performance on quality measure targets, many of which focused on aspects of routine or preventive care beyond dialysis care. These variations may, therefore, be plausibly explained by the extent to which ESCOs successfully involve primary care physicians (PCPs) in the care of their patients–a decision left to the discretion of individual organizations. PCPs may be particularly effective in the management of this population, given their experience and expertise with coordination of care, their accessibility, and their generally more holistic view of the patient. Thus, an ESCO’s success at curbing spending and improving outcomes for its aligned beneficiaries may depend on its ability to increase interactions between nephrologists and PCPs. Regardless, it remains unclear whether ESCOs offer any added benefit over older primary care-oriented ACO designs like the Medicare Shared Savings Program (MSSP), in which 20% of Medicare beneficiaries on chronic dialysis currently receive their care. We propose a study with the following three Specific Aims: 1) To assess ESCO effects on interactions among nephrologists and PCPs or other specialists 2) To assess the impact that increased PCP involvement has on ESCO financial performance and clinical outcomes and 3) To compare the costs and outcomes of care for chronic dialysis patients as a function of PCP involvement in ESCOs, versus MSSP ACOs. Findings from this work will provide critical information to guide ongoing efforts at reorganization of health care for the dialysis population with the goal of improving the efficiency and quality of care delivered.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $399,999 )
2024	2024	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	000	5	12/21/2023	NON-COMPETING CONTINUATION	$399,999
														Subtotal = $399,999

Issue Date FY: 2023 ( Subtotal = $399,999 )
2023	2023	REGENTS OF THE UNIVERSITY OF MICHIGAN	503 THOMPSON STREET	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	1/23/2023	NON-COMPETING CONTINUATION	$399,999
														Subtotal = $399,999

Issue Date FY: 2022 ( Subtotal = $399,999 )
2022	2022	REGENTS OF THE UNIVERSITY OF MICHIGAN	503 THOMPSON ST	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	1/4/2022	NON-COMPETING CONTINUATION	$399,999
														Subtotal = $399,999

Issue Date FY: 2021 ( Subtotal = $400,000 )
2021	2021	REGENTS OF THE UNIVERSITY OF MICHIGAN	503 THOMPSON ST	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	1/13/2021	NON-COMPETING CONTINUATION	$400,000
														Subtotal = $400,000

Issue Date FY: 2020 ( Subtotal = $400,000 )
2020	2020	REGENTS OF THE UNIVERSITY OF MICHIGAN	503 THOMPSON ST	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	3/25/2020	NEW	$400,000
														Subtotal = $400,000

Grand Total All Awards = $1,999,997

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Primary care involvement in End Stage Renal Disease Seamless Care Organizations (ESCOs) and the quality and costs of care for patients on chronic dialysis

Award Number: R01HS026908

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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