A Transplant-Inclusive Value-Based Kidney Care Payment Model

In the United States, kidney care payment models are migrating toward value-based care (VBC) models incentivizing quality of care at lower cost. Current kidney VBC models will continue through 2026. We propose a future transplant-inclusive value-based care (TIVBC) model designed to supplement current models focusing on patients with advanced chronic kidney disease (CKD) and end stage kidney disease (ESKD). The proposed TIVBC is structured as an episode-of-care model with risk-based reimbursement for "referral/evaluation/waitlisting," "Primary hospitalization to 180 days post-transplant," and "long-term graft survival." Challenges around organ acquisition costs, adjustments to quality metrics and potential criticisms of the proposed model are discussed. We propose next steps in risk- adjustment and cost-prediction to develop as an end-to-end, transplant-inclusive value-based care model. In the United States, kidney care payment models are migrating toward value-based care (VBC) models incentivizing quality of care at lower cost. Current kidney VBC models will continue through 2026. We propose a future transplant-inclusive value-based care (TIVBC) model designed to supplement current models focusing on patients with advanced chronic kidney disease (CKD) and end stage kidney disease (ESKD). The proposed TIVBC is structured as an episode-of-care model with risk-based reimbursement for "referral/evaluation/waitlisting," "Primary hospitalization to 180 days post-transplant," and "long-term graft survival." Challenges around organ acquisition costs, adjustments to quality metrics and potential criticisms of the proposed model are discussed. We propose next steps in risk- adjustment and cost-prediction to develop as an end-to-end, transplant-inclusive value-based care model.