Impact of a health system’s population health implementation of Medicare’s “Kidney Care First” program: a retrospective cohort study

Abstract Background Chronic kidney disease (CKD) affects more than one in seven US adults and accounts for a disproportionate share of Medicare expenditures. Medicare’s Kidney Care First (KCF) model represented a shift toward value-based care for patients with advanced CKD, yet evidence regarding its real-world effectiveness remains limited. We evaluated the impact of a population health intervention – the Kidney Care Medical Home (KCMH) program – on health care utilization outcomes in response to KCF. Methods We conducted a retrospective cohort study of 926 KCF-enrolled and 551 control beneficiaries from 2021 to 2023. The intervention included complex care management, depression screening, kidney education, and emphasized referrals to transplant specialists and shared decision making on dialysis. We employed the Callaway and Sant’Anna difference-in-differences estimator to measure quarterly average treatment effects on the treated (ATET) for primary (all cause emergency department visits and hospitalizations) and secondary outcomes (home dialysis utilization, transplant nephrology referrals, and behavioral health referrals), adjusting for age, sex, social vulnerability index, dual eligibility, and comorbidities. Results KCF enrollment was not associated with statistically significant reductions in all cause emergency department visits (quarterly ATET ranging from − 3.09 to + 2.80 per 100 patients) or hospitalizations (-3.00 to + 6.60 per 100 patients). However, home dialysis increased substantially by Q4 2023 (+ 4.96 per 100 patients), transplant nephrology referrals increased in Q3 2022 (+ 1.5 per 100 patients) and Q4 2022 (+ 1.7 per 100 patients), and behavioral health referrals increased by Q2 2022 (+ 3.9 per 100 patients). Conclusions A comprehensive KCF-aligned care coordination program was not associated with short-term reductions in acute care utilization but was associated with meaningful improvements in home dialysis uptake, transplant referrals, and behavioral health engagement. Future payment models should consider aligned financial incentives, extended evaluation periods, and primary care coordination to realize the full potential of value-based kidney care in predominantly fee-for-service environments.