More than Kidney Care

We are modernizing the delivery of healthcare to Medicare patients with End-Stage Renal Disease

Renal Payer Solutions LLC

Renal Payer Solutions, LLC (RPS) has been developed to address the significant treatment issues for individuals with End-Stage Renal Disease (ESRD). The Company is a Medicare Advantage Prescription Drug Plan (MAPD) Special Needs Plan caring for individuals with End Stage Renal Disease. Treatment of ESRD is demanding, multifaceted and complex, requiring strict patient adherence to treatment protocols in order to achieve favorable health outcomes and satisfactory quality of life.

Nonadherence to treatment among dialysis patients is widely recognized in the renal community as an important contributor to suboptimal treatment and poorer health outcomes. The results of nonadherence to treatment are increased and avoidable medical costs. Dialysis patients face intricate challenges in consistently maintaining their prescribed routine of limiting fluid intake, maintaining dietary requirements, attending regular hemodialysis sessions, and taking multiple medications. Nonadherence can lead to avoidable hospitalization, adverse health effects, or even death. As an MAPD Health Plan, RPS is a business that will support the member, caregivers, and providers of Medicare beneficiaries with ESRD, helping all to live an improved life, reduce avoidable healthcare expenses and enhance the overall well-being of the Health Plan’s members.

The MAPD market, in general, is extremely competitive, and entering the market can be challenging. With the passing of the 21st-century CURE’s act in 2021, the federal government is pushing to make ESRD more efficient and reduce the cost of care. In 2018, there were 519,000 individuals receiving dialysis services in the USA, with the majority of those patients insured through Medicare FFS. That number is increasing by about 3% per year. Developing a strong MAPD SNP Plan for Medicare beneficiaries with ESRD is attractive to patients, caregivers, and providers as patients and providers receive more support of their care than in the Medicare fee-for-service system, patient cost of care is reduced, and providers will have the opportunity to share in savings to the overall cost of care. The ESRD market is one of the few Medicare populations that have an opportunity to grow without significant initial marketing and enrollment costs.

What we do

Renal Payer Solutions, LLC is a health plan company that will offer managed care insurance as well as manage and provide services in support of specialty services managed care programs for renal dialysis members. RPS will contract with Payors and governmental entities on a monthly capitated payment and in exchange RPS will provide all covered services for eligible members. RPS establishes contracts with health care providers to provide or arrange covered services on a captitated or fee-for-service basis for enrolled members. The health care providers include IPAs. RPS provides or arranges for management services to be provided for the day-to-day operations of the IPAs in exchange for a management fee under a management services contract. RPS otherwise operates the managed care enterprise, including utilization review and related programs, and coordinates the care provided to patients assigned as members to it by the various payors. RPS intends to operate initially in four states, California, Arizona, Nevada, and Texas, and plans to operate more broadly in the future.

Who we are

The Founders of the Company are a formidable team possessing varying skills, who are uniquely qualified to deliver company vision and goals. Jerome Tannenbaum, MD is an experienced Nephrologist and Dialysis operator, who has successfully grown and operated three national dialysis companies. He has developed an innovative and supportive approach to allow for successful home hemodialysis service. Jeffrey Davis and Jay Davis each have nearly 40 years of experience each developing and managing Health Plans, with experience managing populations with difficult and complex medical and behavioral conditions. Michael Wong, DO has experience growing and managing medical groups and IPAs as well as a long history of providing patient care. A team is being developed with diverse experience in the medical delivery of complex populations to support the company

Renal Payer Solutions Key Elements

RPS is an integrated, vertically positioned medical delivery system Health Plan which provides optimal care for ESRD patients who are within the Medicare HMO system. We provide innovative and comfortable home-based hemodialysis coupled with integrated lab, RPM, telehealth and total care pharmacy that decreases our members’ hospitalizations and increases their personal comfort and that of their family. Our partners are leading nephrologists across the U.S. who have longstanding patient relationships, have chosen to serve as the primary treating provider and have joined RPS in an equity position so that all parties are in financial alignment, therefore creating an optimal treatment scenario for all RPS members.

As a result of the 21st Century Cures Act amendment to the Social Security Act, ESRD patients are now able to join Medicare HMO providers and therefore enjoy the enhanced benefits that MAPD plans such as RPS provide. The ESRD market in the United States is currently 558,000 people. These patients are currently on dialysis and represent a Medicare spend of $49 billion dollars. There are an estimated 37 million people with chronic kidney disease in the U.S. representing medical costs of $70 billion. The market is very large. Regarding just the ESRD market that can be served by RPS through its current relationships, there exists an opportunity to serve 50,000 ESRD patients in partnership with our U.S. nephrology groups which represents an annual top line premium revenue to RPS of $6 billion/annually.

RPS has quite a unique offering for the previously fee-for-service nephrology groups. Our partner nephrologists will serve as the primary treating providers (PTP) for their current patients. They will now enjoy capitation for their entire treatment populations and become part of the vertically integrated delivery system, which includes all the necessary components which will provide optimal patient care and comfort while aligning them financially with the RPS model of capitation and equity. The members will enjoy home based care with more “touch points” with all RPS providers as well as the enhanced benefits that Medicare HMO provides. This will enable RPS to fill care gaps and avoid unnecessary hospital admissions.

RPS offers our providers a singular value proposition. We will partner with them to optimize their care, create system efficiencies for better patient outcomes. Our mission is to provide the best comfort and care with our care coordination and interventional services, while aligning the incentives of the provider with the company. Our value is a simple capitation for their participating population and equity in the company. The delivery system will now be more focused and efficient for the members, which will ultimately provide more comfort and assurance for them and their loved ones.

RPS was founded by leaders who have proven that they could create better care for the underserved in both rural and urban areas. The ESRD population has been subject to spending a majority of their lives in dialysis center for long hours and with often inconvenient schedules. They endure this week after week with no end in sight. RPS will strive to position them back in the comfort of their homes or at least in a smaller, more intimate setting along with our caring providers every step of the way. We aim to give our member back a bit of their lives and give them more time with their family. All while moving in earnest to avoid additional hospitalizations for them

At RPS we avoid the conventional wisdom. Our leaders have entered into and proven that the most difficult populations, whether they be the rural underserved, the new immigrant populations or the persistent mentally ill, deserve the best care available. We have done this across the United States and are now poised to provide the same high level of care to the ESRD and CKD senior populations. In order to succeed, we have aligned with renal providers with whom we have had previous partnerships, relationships and friendships for the past 40 years. RPS was formed by leaders from both provider and payer sides of the fence. Our founders have built hospitals, dialysis centers, IPAs, medical groups and Medicare Advantage HMO plans. Both payer and provider have aligned to create harmony in delivering care to this challenging population.

Renal Payer Solutions was founded as a result of the culmination of both physicians and health plan leaders. Our DNA resides where it should be, we are healthcare leaders, not insurance people. Our two physician founders built leading care facilities, medical groups, independent practice associations and countless provider relationships in the past four decades. Our health plan founders were previously pioneers in the managed care world and successfully operated a large MAPD plan in 22 counties covering California. We have been joined by industry “doers” who are poised to bring our care system to California and multiple other states.

RPS will partner with a California RKK and immediately enhance the California network. This will allow ESRD and CKD patients in California to enter into a Medicare HMO and enjoy the RPS care system in 2022. We have filed for full MAPD plans in Arizona, Nevada and Colorado with the intention of providing care to our nephrology partners’ members in 2023.

RPS is focused on achieving Plan status in California and surrounding states expeditiously. We have leveraged partnerships to quickly achieve these first mover, go-to-market necessities. Our partnerships with leading nephrology groups who have an equity stake will allow us to focus our resources on care instead of marketing to enroll members. We are then able to focus future spending on our “interventional businesses” which include pharmacy, laboratory, vascular access, imaging, home health and importantly home hemodialysis.

For more information

Dr Mike Wong, Chief Strategy Officer, (949) 701-1133, drmhwong@gmail.com Renal Payer Solutions, 19700 Fairchild Road, Suite 230, Irvine, CA 92612

Our Team

Care for Patients, Not Just Kidneys

Our high-touch clinical team, powered by predictive analytics, identifies patients early and cares for the whole patient from Chronic Kidney Disease (CKD) through End Stage Renal Disease (ESRD), managing patients’ co-morbid conditions and addressing social and behavioral needs. Strive Health is a turn-key solution for your kidney disease population.

Get in Touch

Let’s do better for kidney disease patients and improve our kidney care system together. Contact us now!

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Contact Us

Dr. Mike Wong at mwong@renalpayer.com

Renal Payer Solutions, LLC

Corporate Headquarters 511 Union Street, Suite 1800 Nashville, TN 37219

Administrative Offices

19700 Fairchild Rd, Suite 230 Irvine, CA 92612