DIRECT CONTRACTING ENTITY (DCE)
Background
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Renovis Health is Medicare Direct Contracting Entity (DCE).
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Providers are subject to a fee for service reduction rate of 5% for PY2.
CMS Background
- The Center for Medicare & Medicaid Innovation (the Innovation Center) with CMS supports the development and testing of innovative health care payment and service delivery models.
- The CMS Innovation Center has a growing portfolio testing various payment and service delivery models that aim to achieve better care for patients, better health for communities, and lower costs through improvement of the CMS health care system.
RENOVIS ADVANTAGES & GOALS
Provider Advantages at Renovis:
Providers' beneficiaries health coverage does not change
Providers participating in a Shared Savings Program
Providers being able to bill FFS in PY1 and PY2
Renovis will achieve CMS goals by:
Creating prospective spending targets for care providers
Utilizing voluntary alignment forms to increase care providers’ patient size Creating patient engagement Incentives for care providers
Establishing core quality measures for care providers
Educating providers on *waivers to facilitate care delivery
Allowing opportunities for organizations new to Medicare FFS to participate
Renovis Plan
Enhanced care coordination for beneficiaries.
Provide beneficiaries with elevated benefits and incentives for care management.
Provide beneficiaries the option of lowering out-of-pocket costs.
Ensuring existing Medicare benefit rights are protected.
Benefits with joining Renovis DCE
Benefit enhancements for participants and patients:
- 3-day SNF Rule waiver
- Telehealth Expansion waiver
- Post-Discharge Home Visit Rule waiver (allows providers to do up to 9 visits even if the patient does not meet the home bound criteria within 90 days from discharge)
- Care Management Home Visit rule waiver (allows providers to do up to 12 visits within a calendar year if they suspect the beneficiary is at high risk of hospitalization)
- Allowing Nurse Practitioners to certify patients are eligible for home health services
- Allowing provisions of home health services to beneficiaries who are not homebound
Questions and Answers
Renovis Health (“Renovis”) is part of a Medicare Shared Savings Program. Renovis physician partners have over fifty years of experiences in delivering quality health care to Medicare and Medicaid beneficiaries. Renovis was granted one of the fifty-three Medicare Direct Contracting Entity, part of the Center for Medicare & Medicaid Innovation (CMMI). Renovis services the most chronically ill of traditional Medicare patient population with mobility issues, serve debilitating diagnoses and/or frequent hospitalization.
How is your company advancing home care medicine?
Renovis Health (“Renovis”) goal is to give members the greatest opportunity to succeed at healthier living and self-management living in home. A primary objective of our integrated program is to Reduce Complications resulting in Reduced ER visits, Hospital Admissions and Nursing Home Admissions, utilization, and costs. Renovis accomplishes its mission through enhanced medical services, such as:
• Same-Day Sick Visits
• Transition of Care Visits
• Same-Day Diagnostic and Lab procedures with same day results through our Enhanced Care Management Services.
Renovis provides for the assessment, identification and care planning of social determinants of health, well-being and behavioral needs. Care management services complete the circle of care. Our care management service delivery emphasizes frequent patient engagement though multiple methods of outreach including face-to-face in the home or facility; telephonic; via our web portal; secure two-way messaging; secure email; and, standard mail and fax. We perform meaningful and actionable analytics and quality reporting to providers and care management for effective decision support.
What is something people may not know about your company?
Renovis Health (“Renovis”) partners with organizations that lead the nation in: lean management, patient quality servicing, customizing medical technology, providing quality healthcare providers to manage care, 24/7 access to physician groups and clinical staff. Renovis intensive primary care and enhanced care management service model is designed to engage patients more frequently addressing effectively their clinical, social, well-being and behavioral needs.
* Effective 1/1/2023, formerly know as a direct contracting entity