DIRECT CONTRACTING ENTITY (DCE)
Background
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A DCE is a legal entity which participates in Direct Contracting pursuant to a Participation Agreement with CMS. Under Direct Contracting, there will be three types of DCES - Standard DCES, New Entrant DCEs, and High Needs Population DCES.
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The Direct Contracting path, together with the Primary Care First payment model options and the updated Medicare Shared Sayings Program ENHANCED Track, are part of the CMS strategy to use the redesign of primary care to drive broader delivery system reform to improve health and reduce cost.
Renovis Health
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Renovis Health is CMS approved as a Global DCE aligned to High Needs Population; a DCE that serve FFS Medicare beneficiaries with complex needs, including dually eligible beneficiaries, who are aligned through voluntary alignment or claims-based alignment.
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Renovis Health is taking global total cost of care risk on their patient population (responsible for Part A and B expense; will be done through PCP and their beneficiaries)
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 we suspect of 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