By: Austin Campbell, PhD,
Senior Vice President, Strategy
Quality comes first. Everything else follows.
The goal of value-based kidney care is not simply to spend less. It’s to help patients with advanced kidney disease receive the right care at the right time, avoid preventable complications, and achieve better outcomes.
That’s why the CKCC model was created. Over the past three years, Evergreen has partnered with nephrologists across the country to build the care coordination, patient support, and interdisciplinary infrastructure required to improve quality at scale.
As new analyses of CKCC emerge, one conclusion is becoming increasingly clear: nephrologist-led, value-based kidney care can improve quality and transform care delivery. While we did not agree with all of the conclusions drawn from the PHTI report, the discussion underscored an important reality: lasting improvements in kidney care are achieved through comprehensive care models that combine clinical leadership, care coordination, patient support, and appropriate use of technology. CKCC was designed to enable exactly that approach.
While discussions often focus on whether short-term savings reached a particular threshold, quality improvement was always the foundation of the model. The encouraging news is that better outcomes and lower costs no longer need to be competing objectives.
Seeing Beyond the First Signals
Early evaluations of CKCC have focused on Medicare spending during the model’s initial years. While those findings are important, they don’t fully capture how physician-led care models mature and improve over time.
Focusing solely on short-term spending also risks overlooking the model’s early quality gains. In its evaluation of 2023 performance, CMS reported improvements across several important outcomes, including a 31% increase in Optimal ESRD Starts, a 10% increase in home dialysis rates, a 22% increase in rates of living donor transplants, and a 37% increase in preemptive waitlisting. These are meaningful indicators that more patients are receiving planned, proactive care rather than making life-changing treatment decisions during a crisis.
The recently released Wakely study, Reassessing the Early Results from Medicare Kidney Care Models, provides important context. It estimated that if the 2026 payment methodology had been applied to earlier performance years, the CKCC model would have generated net savings of $26 million in 2023 and $90 million in 2024.
Even though quality comes first, those findings suggest savings may be on the way. CMMI’s revisions have created a structure that would have generated savings in the program’s early years, which is extremely uncommon in value-based care. As the program matures, that structure has the potential to create value for taxpayers, while continuing to improve outcomes for patients.
To me, that’s the most important takeaway. It suggests the care model is evolving, and the refinements CMS has already made are strengthening the underlying approach.
The more important question is how those lessons should shape the next generation of kidney care models.
Designing Care Around Patients and Physicians
Kidney disease is one of the most complex conditions in healthcare. Patients are often managing multiple health issues while facing barriers that go far beyond clinical care. That’s why the model for care has to look different.
Our model is designed around close alignment with physicians, who are uniquely positioned to influence the course of kidney disease when supported by the right resources, data, and infrastructure. Evergreen works alongside them to extend care beyond the clinic by supporting patients between visits and making additional resources available to nephrologists.
CKCC is designed to align care around what matters most.
For patients, that means having the right resources earlier in their health journey, so they are never forced to make critical decisions about dialysis or transplant in a moment of crisis. Models like CKCC empower patients by reducing avoidable complications and strengthening their confidence in managing their health.
For nephrologists, it provides the support and resources to deliver more proactive, connected care. And for the healthcare system, it means creating a model that rewards sustained outcomes, rather than isolated episodes of care.
This is how a more connected approach to care can drive better outcomes—for patients, providers, and the system as a whole.
One of the clearest lessons from KCC has been the critical role nephrologists play in changing the trajectory of kidney disease. When physicians are supported with the tools, data, and care teams they need, they can deliver higher-quality, more coordinated care.
Real change happens before it shows up in claims data. It starts with building trust with patients as they navigate the complexity of kidney disease and reinforcing the care plans our physician partners are leading by closing care gaps that traditional models miss.
I’ve seen this firsthand through the relationships we’ve built with our partner nephrologists. I’ve had the opportunity to work alongside providers who are delivering more connected, proactive care and reaching patients earlier in their journey.
Looking Ahead
As CMS develops the next generation of kidney care models for 2028 and beyond, I believe the opportunity is to build on what we’ve learned.
The early years of CKCC have demonstrated that physician-aligned care models can improve engagement and outcomes for patients managing complex kidney disease. That’s an important lesson, and one worth carrying forward as CMS shapes the future of kidney care.
The direction is clear. When care is organized around the patient and sustained over time, it leads to better outcomes and a stronger foundation for long-term care.
