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Comprehensive ESRD Care Initiative

The Comprehensive ESRD Care initiative was designed to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease (ESRD). Through the Comprehensive ESRD Care initiative, CMS will partner with health care providers and suppliers to test the effectiveness of a new payment and service delivery model in providing beneficiaries with patient-centered, high-quality care.


Beneficiaries with ESRD have significant care needs. These beneficiaries constituted 1.3% of the Medicare population and accounted for an estimated 7.5% of Medicare spending, totaling over $20 billion in 2010. These high costs are often the result of underlying disease complications and multiple co-morbidities, which often lead to high rates of hospital admission and readmissions, as well as a mortality rate that is much higher than the general Medicare population. Because of these complex health needs, beneficiaries often require visits to multiple providers and follow multiple care plans, which can be challenging for beneficiaries if care is not coordinated. Through enhanced care coordination, these beneficiaries will have a more patient-centered care experience, which will ultimately, improve health outcomes.

Initiative Details

Through this new initiative, CMS will partner with groups of health care providers and suppliers – ESRD Seamless Care Organizations (ESCOs) – to test and evaluate a new model of payment and care delivery specific to Medicare beneficiaries with ESRD. Participating ESCOs will be clinically and financially responsible for all care offered to a group of matched beneficiaries, not only dialysis care or care specifically related to a beneficiary’s ESRD.

Eligibility and How to Apply

On February 03, 2013, CMS will begin accepting letters of intent for the Comprehensive ESRD Care Initiative. For more information, visit the application page.

Additional Information

Questions about the Comprehensive ESRD Care Initiative application, or the initiative generally, can be sent to


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