Background

DCEs, or Direct-Contracting Entities offer the ability to contract directly with Medicare rather than contracting through a health plan or other managed care entity. While DCEs offer groups which have not generally participated in managed care arrangements a means of participating in risk arrangements directly with Medicare, any HIPAA compliant organization (such as a Medical Group Practice, an ACO, an Integrated health care system, or an MCO can become a DCE). DCEs offer Medicare the means of exploring, studying, and engaging the provider community in risk sharing arrangements. Risk sharing arrangements may vary from Global Risk to Professional Service arrangements and may involve Total Care Capitation or Primary Care Capitation. Advanced Payment Options may allow DCEs, participating in less than Total Care Capitation, the option of providing capitation to hospitals or other vendors in the community. Geographic DCEs are also a new offering and will initially focus on limited geographic areas in the US. They allow select organizations to receive, under one umbrella, randomly aligned Medicare FFS patients not otherwise participating in managed care. Geo DCEs will offer MCOtype global risk arrangements to suitable organizations.

Medicare’s DCE project will occur over a defined 6 year period. Performance Year 1 (PY1) starts in April of 2021. Beyond PY1, future Performance Years will track the annual calendar with PY2 starting in January of 2022.

Our founder and CEO is Dr. Reginald Eburuche. He is assisted in his role by Olisaeloka Dallah, our COO, and Dr. Bobby Lee, our CMO.

Dr. Eburuche brings nearly two decades of experience in primary care, home-based primary and acute care, long-term care, and complex medical management to our ventures. Renovis Health is his Vision.

Olisaeloka Dallah, E-MBA, brings nearly two decades of experience from many different industries to our practice. His extensive project management experience, experience in the health care, entertainment, hospitality, and regulatory industries offers a unique opportunity to build a business model which is truly patient centered and of the highest degree of patient engagement. His experiences as a certified fraud examiner will propel our fraud, waste, and abuse initiatives as we eventually incorporate true MCO offerings into our model on behalf of health plans.

Dr. Bobby Lee brings nearly two decades of experience in hospital-based care, palliative care, and MCO management to Renovis. Dr. Lee participated in prior CMS dual-demonstration projects and understands the importance of network management and engagement as we build a robust network of engaged physicians, physician practices, and community service organizations into the Renovis Care Model.

Renovis Health is a DCE comprised of a number of allied practices. Each practice will retain management responsibility for participation but a common board will represent the practices collectively. This board of directors will act independently (within the auspices of the DCE and risk-bearing contracts) of each practice. The CEO of Renovis Health will serve as the Chairman of the Board.

Each practice will remain as independent functioning entities as regards the care of non-DCE beneficiaries.

An able-management team (CFO, Compliance, CM, Quality) rounds out Renovis health and will support a stable and progressive medical service organization which will support the high-risk patient management needs of allied practices and partners.

Please refer to Renovis Care Plan for Org Chart.

Our DCE’s initial opportunity will be defined by CMMI’s Direct Contracting Entity Offering. We will use this offering and phased implementation to transition from provider-based (traditional) medical practice(s) to a global-risk bearing entity adept at managing capitated contracts.

We will become a practice that benefits from a structure resembling that of a Dual-special Needs program (D-SNP) or Medical Service Organization (MSO) that becomes a primary vehicle for area health plans (or health systems) to manage their sicker and needier (highest risk) patients in the community

Our practice structure will begin as a traditional FFS practice and will gradually transition to a practice that progressively engages the total-health needs of our population (social and behavioral determinants of health).

Our model will be a high-touch patient care model with frequent clinical, care management, and care coordination encounters

We will strive to support our physicians and advanced practice providers with appropriate care coordination and care management.

General staffing within the medical clinics will, presumably, follow the directives of the physician, or physician group, managing that practice. Industry-specific care- management staffing standards and ratios will be used to support their practices based on the number of dual-eligible beneficiaries enrolled in Renovis Health.

Reporting FROM CMS

Core Quality Data-Set

Finance

Eventual Metrics to support Health Plan engagement

Social and Behavioral Determinants of Health