ESRD Population Risk Based Management Services

The Vendor is required to provide a risk bearing entity to design and provide proactive population health management for members with early-stage kidney disease through End Stage Renal Disease (ESRD), provide a kidney care program, and ensure members are receiving all benefits they are entitled to. Work is to begin in February, 2026.
- Our mission is to inspire and partner to create quality and equity in individual and community health. 
- Our vision is healthy communities for all individuals, regardless of income or social circumstances.
- Identify and intervene early/proactively with members who have early-stage kidney disease.
- Create initiatives to increase the proportion of clinic-based and home-based dialysis and to increase the proportion of peritoneal dialysis versus hemodialysis where medically appropriate.
- Program management must incorporate culturally competent care and social determinants of health-related initiatives.
- Care management, including coordination of medical and support services.
•    Employ virtual or telehealth care service options for members.
•    Manage provider feedback, complaints, and questions regarding patients or
•    Proposer’s services.
•    Pre and post kidney transplant care coordination.
•    Provide enrollment assistance services.
•    Reduce inpatient admissions for members with ESRD.
•    Ensure continuity of care during transitions (hospital to home, dialysis center to transplant).
- Management of nephrology services and dialysis network relationships.
•    Establish value-based agreements with providers of primary care, specialty care, and dialysis providers to incentivize quality, financial equity, health equity, and growth outcomes.
•    Promote integrated model of care for primary care, specialty care, kidney transplant services, and dialysis providers.
•    Manage kidney disease members’ medication adherence as evidenced by Healthcare Effectiveness Data and Information Set (“HEDIS”) medication adherence measures.
•    Establish utilization management and accounting process to optimize utilization of the various types of renal replacement therapy.

- Contract Period/Term: 2 years
- Questions/Inquires Deadline: December 22, 2025