When you or a loved one is diagnosed with chronic kidney disease (CKD), you are well aware of how daunting and complex life can be when dealing with the condition. It is a lot to deal with between doctor visits, dialysis, medications, and lifestyle changes and the healthcare system does not always help.

That is where the Kidney Care Choices (KCC) Model is.

Introduced by Medicare (CMS), the KCC Model is a novel kidney care model in favor of greater coordination, timely treatment, and providing patients with increased options, particularly those related to such options as home dialysis and kidney transplants.

As opposed to the old one-size-fits-all model, the KCC Model invites doctors and healthcare professionals to collaborate to provide high quality personalized care that literally places the patients at the center.

As a matter of fact, the CKCC option of the Kidney Care Choices (KCC) model has achieved a 16 and 31 percent increase in Optimal ESRD Starts (planned starts of renal replacement therapy) during the first year (PY 2022), and the second year (PY 2023), respectively, compared to a pre-model comparison group.

This is a statistically significant improvement in the way the patients of End-Stage Renal Disease (ESRD) are initiated into care.

In this guide, we will break down what the KCC Model is, how it works, who it is for, and why it matters. Let us explore together. 

What is the Kidney Care Choices (KCC) Model?

The Kidney Care Choices (KCC) Model is a healthcare program launched by the Centers for Medicare & Medicaid Services (CMS) in the U.S. Its main purpose is to improve how patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) are treated.

In simple terms, it is a new way of organizing kidney care so that patients get:

• More personalized treatment
• Better support before dialysis
• Help with kidney transplants
• Fewer hospital visits and emergencies

Instead of just treating kidney failure when it happens, the KCC Model focuses on prevention, early treatment, and giving patients options they might not have had before.

You can think of it as a team-based approach. Doctors, nurses, and care managers work together with the patient. The model is designed so that providers (hospitals, nephrologists, and dialysis clinics) are rewarded when patients stay healthier and avoid complications.

Goals and Objectives of the KCC Model

The KCC Model has some very clear goals, all built around patients first. Here is what it aims to achieve:

1. Early Intervention

   • Encourage care before the kidneys fail.
   • Help patients manage CKD in its earlier stages.

2. More Transplants

   • Increase the number of people who get a kidney transplant.
   • Make sure patients know their options beyond dialysis.

3. Better Dialysis Choices

   • Support home dialysis so that the patients do not always have to go to a clinic.
   • Improve education on different types of dialysis.

4. Improved Quality of Life

   • Reduce emergency hospital visits.
   • Provide patients with support services like diet counselling and mental health resources.

5. Cost Savings

   • By keeping patients healthier, the system saves money.
   • Providers are rewarded for quality, not just quantity, of care.

Who Can Participate in the KCC Model

Not everyone can just sign up for this program. It is designed for specific groups of providers and patients.

For Providers

Healthcare organizations can join if they are:

• Nephrologists (kidney doctors)
• Dialysis clinics
• Transplant centers
• Hospitals that treat kidney disease patients

For Patients

Patients who are eligible include:

• Those with late-stage chronic kidney disease (CKD stage 4 and 5)
• People already on dialysis
• Medicare patients (since this is a CMS program)

How Does the Kidney Care Choices Model Work?

Now that we know what the Kidney Care Choices (KCC) Model is all about, let’s look at how it actually works in real life. 

1. Providers sign up to be part of a team.
2. Patients are automatically assigned to that team.
3. Care is coordinated so that the patients have fewer complications.
4. Financial incentives ensure providers stay focused on outcomes, not just services.
5. Patients receive care that is proactive, personalized, and empowering.

1. Providers Sign Up

The program starts with healthcare providers. These include Nephrologists, dialysis centers, hospitals, and transplant centers.

All these groups come together to form something called a Kidney Contracting Entity (KCE).

A KCE is like a team or network. Everyone in the team agrees to work together, share information, and take responsibility for the health outcomes of the patients they serve.

This is a big shift from the traditional system, where each clinic or doctor worked separately. Now, the focus is on collaboration.

2. Patients Are Assigned

Once a KCE is formed, Medicare identifies eligible patients and connects them to the program. 

Patients don’t have to fill out applications or paperwork to join. If their doctor or dialysis centre is part of a KCE, they are automatically linked to the model.

The goal is to ensure patients do not fall through the cracks. Instead of being juggled between different doctors and clinics, they are given coordinated care under one system.

3. Care Coordination Happens

This is the heart of the KCC Model. Patients gain access to a care manager, who serves as their personal guide through the complex world of kidney care. This part is all about giving patients the tools, knowledge, and support they need to take control of their health.

With the growing role of digital health, platforms like TelliHealth make it easier for patients to stay connected to their care teams remotely. From monitoring vitals at home to receiving guidance without needing constant clinic visits, these tools strengthen the KCC Model’s goal of proactive, patient-centered care.

Here’s what care coordination looks like in practice:

• Appointments: Ensuring that patients are not late to doctor visits.
• Medications: Assistance with prescriptions and preventing medication interactions.
• Dietary Support: Helping patients to know which foods and which foods to avoid to preserve the kidney health.
• Lifestyle Support: Promotion of healthy lifestyles such as physical exercise and fluid management.
• Education: Educating patients on the options of dialysis, the process of transplants and what can be done to slow down the damage of the kidneys.

4. Financial Incentives Kick In

Rather than the traditional fee-for-service, in which providers earn money on an individual basis per test or procedure, the KCC Model provides incentives to providers with improved outcomes. This method does not focus on quantitative (number of services offered) but rather on quality (how well the patients are doing).

That means:

• If a patient stays healthier and avoids hospital visits, the providers share in the savings.
• If a patient successfully receives a kidney transplant, providers are financially rewarded for supporting that process.
• If patients use more cost-effective treatments like home dialysis, that also counts as a win.

5. Patient-Centered Care is Delivered

The result is that patients no longer feel like they are navigating the system alone. Instead of care being reactive, only addressing problems when they arise, it becomes proactive and aims to prevent problems before they happen. This model is designed to give patients confidence, control, and dignity in managing their health.

Patient-centered care under the KCC Model means:

• Patients are informed of all their options, not just pushed toward dialysis.
• Care is tailored to individual needs rather than a one-size-fits-all approach.
• Patients have a whole team supporting them, not just a single doctor.

Benefits of the KCC Model

This model brings a lot of positives for both patients and providers. Let us break them down for you.

For Patients

• Better Education - Patients are educated on their disease, diet and treatment options.
• More Choices - Patients may be given home dialysis or transplant as an alternative to being compelled to in-clinic dialysis.
• Continuity of Care - Patients do not have to be able to see a different doctor each time.
• Better Quality of Life - Because of reduced hospitalizations, patients have increased family time at home.
• Support Beyond Medicine - Access to dieticians, counselors and care managers.

For Providers

• Financial Rewards - Providers are encouraged to keep patients healthy rather than being paid to provide services only.
• Team-Based Care - Doctors, nurses and specialists work together, resulting in improved outcomes.
• Lower Costs - Complications would be avoided, resulting in fewer costly emergency care.
• Patient Trust - Healthier and happier patients have more trust in their providers.

Challenges

Of course, no system is perfect. The KCC Model faces some real challenges:

1. Complexity

The program involves many moving parts, including doctors, clinics, hospitals, and insurers. It can be difficult to coordinate everything smoothly. 

2. Provider Readiness

Not all providers are ready to shift from the old system to this new one. Smaller clinics may struggle with resources.

3. Patient Awareness

Many patients are unaware of the program, and education takes time and effort.

4. Financial Risks

Providers make savings but they also share risks, this implies that when the outcomes are not good in the patients, the providers can lose money.

5. Cultural Shift

Patients and providers are used to traditional dialysis-centered care. Moving to prevention and home-based care requires a mindset change.

Conclusion

Kidney disease is often called a “silent killer” because it develops slowly and without obvious symptoms. By the time many people realize, it is too late to reverse the damage.

Here’s why the KCC Model matters so much:

• It empowers patients with knowledge and choices.
• It reduces suffering by preventing emergencies and complications.
• It saves lives through earlier transplants and better dialysis options.

Kidney Care Choices (KCC) Model is a change of thought in the way we approach kidney disease treatment. The model does not deal with patients when they are at the crisis point, but it is interested in prevention, early intervention, and individual support.

To patients, this translates to increased education, increased treatment, and quality of life. In the case of providers, it entails responsibility, teamwork and financial incentives of doing the right thing.

Yes, there are challenges, from complexity to awareness. But the direction is clear, healthcare is moving towards models that put patients at the center. And for kidney disease patients, the KCC Model offers hope, choice, and a chance at a healthier future.

So, if you or a loved one are dealing with kidney issues, keep this model in mind. Ask your doctor if your care provider is part of the program**.**