Addressing Chronic Kidney Disease

More than one in seven U.S. adults has chronic kidney disease, raising their risk for other serious health problems like heart disease and stroke. Left untreated, chronic kidney disease can progress to kidney failure, known as end-stage renal disease (ESRD). To survive, patients with ESRD must undergo dialysis or receive a kidney transplant.  

Our Work

End Stage Renal Disease Treatment Choices Model Operations

Health and socioeconomic disparities are a major contributor to chronic kidney disease and ESRD, and AIR supports the Centers for Medicare and Medicaid Services (CMS) in efforts to improve care for people with ESRD. For example, the ESRD Treatment Choices Model (ETC Model), which aims to encourage home dialysis and kidney transplants, is among the first CMS models to incorporate health equity into provider performance scoring and payment incentives.

Approximately 130,000 Medicare beneficiaries are attributed to the ETC Model, which spans 3,600 dialysis facilities and 3,400 clinicians, largely nephrologists. As the ETC Model Operations Support Contractor, AIR provides program analysis and operations support for all implementation activities in the following areas: rulemaking support; participant identification and management; beneficiary attribution; execution of payment methodologies, including benchmarking, calculation of performance scores, and payment adjustments; regular reporting on model trends and performance; documentation of all business, functional and technical requirements, including detailed business process models; development of technical specifications and implementation methodologies; and providing technical assistance to internal and external stakeholders.

ETC Model details are available on the CMS ETC Model website and data on the performance of ETC Participant Managing Clinicians and ESRD facilities are available on

Kidney Care Choices Model Program Analysis and Operational Support

Similarly, AIR supports the CMS Kidney Care Choices (KCC) Model, which is aimed at helping providers improve outcomes and reduce cost of care for patients with late-stage chronic kidney disease and ESRD by encouraging home dialysis and kidney transplantation. The KCC Model is an accountable care organization (ACO) payment and delivery model that brings together dialysis facilities, nephrologists, and other providers to test innovative payment mechanisms.

AIR’s work spans four technical domains: managing model participants, aligning beneficiaries to each ACO, processing and analyzing claims to determine shared savings, and measuring the quality of care that ACOs provide to aligned beneficiaries.