In addition to risk corridors, stop loss coverage will be purchased to protect against DCE losses. As mentioned in #1 above, there is zero risk for individual providers.

Providers can opt out at anytime with a 30 day notice provided to CMS.

DC Participant Providers may attain Qualifying APM Participant (QP) status for a year that may be entitled to an APM Incentive Payment and be exempt from MIPS reporting requirements and payment adjustments. However, Preferred Providers are not eligible for QP status under the Direct Contracting Model. For additional questions related to MIPS and the APM Incentive Payment, you can see the qpp.cms.gov website for more details or contact the Quality Payment Program help desk at qpp@cms.hhs.gov.

Quality reporting measure will be composed of: CAHPS survey to ensure 24/7 patient access to practice (DCE to provide 24/7 nurse call center to meet this measure); Unplanned admissions (claim based); Readmissions (claims based); Proposed test measures (Days spent at home; claims based, and Care Coordination (claims based to be completed by DCE).

Yes, based on the Primary Care Capitation chart: Providers to receive shared savings distribution for each of the 6 years that they participate; Year 1 you will continue to be paid 100% fee for service plus shared saving; Year 2, you will be paid 95% fee for service in addition to monthly capitated payment from Renovis and shared savings; and by year 5, your income will be fully capitation and shared savings based. Providers will retain the ability to opt out of any payment year.

The benefit/pro in partnering with Renovis is improvement in delivery of care, resulting in improved outcomes leading to significant savings. Renovis estimates the annual shared savings per patient after expenses to be distributed to providers is $1500-2500. This is assuming a High Needs population (located in metro Detroit, Medicaid secondary, 2 or more chronic medical problems, relatively homebound, history of hospitalization and/or nursing home stay within the past year). Also estimating savings from decreased utilization resulting from pandemic. The average physician should see a 25-100% increase in their income derived from Medicare for their aligned patients.

Due to the pandemic related delay, first distribution will be July 2022. Year 2 will be just 6 months later, January 2023, and subsequent 4 years will be in January as well.

Can enroll throughout the year on mymedicare.gov, paper enrollment forms or through patient portals. List to be provided to CMS every 3 months۔

No. The demonstration is exclusively for patients with traditional Medicare as their primary insurance. Those enrolled in Medicare Advantage Plans and PACE are excluded. If a patient decides to leave their MA plan, then they can be voluntarily aligned to Renovis. However, based on the continued interest in the DCE, Renovis will seek to contract with Advantage plans and extend the opportunity to Participating Providers to participate in those direct contracts as well.