About Retium Health
Retium Health supports health plans to develop Medicare Advantage networks that are compliant with CMS’s network adequacy criteria.
We can assist MA plans across all stages of the CMS network review process:
- Formal Network Review including support with initial provider network submission, triennial network review and consultation process.
- Exception Requests – analysis and preparation of justifications, including pinpointing discrepancies with CMS’s supply file.
- Consulting services across all stages of the network submission and review process, including new market analysis and service area expansions, network coverage, analysis of the ACC report, identification of additional providers.
Who we are
Retium Health provides comprehensive services for Medicare Advantage Organizations that want to ensure that their provider networks meet CMS network adequacy standards. Our team brings over 10 years of direct experience with MA network standards and the CMS network review process.
Retium Health provides clients with:
- Thorough understanding of all the components involved in MA network adequacy.
- Strong capabilities to identify risks in each market and how to address them.
- Clear solutions to resolve CMS concerns
Charlie Bruetman, MD, MBA.
Founder and President Retium Health
Charlie Bruetman, MD is a senior healthcare executive with over 30 years of experience supporting healthcare organizations both in the private and public sectors. Charlie is an expert in policy and regulatory analyses, implementation and evaluation of large programs for the federal government, and strategy consulting for health plans.
Prior to founding Retium Health, he was the Senior Vice President for federal health and human services at The Lewin Group leading a team of over 100 consultants. Responsible for the overall strategy and growth of Lewin’s federal health market, under his tenure, the practice grew tenfold its annual revenue. In addition to managing the federal health market, Dr. Bruetman was responsible for a number of value-based payment initiatives, the development of clinical quality measures, and provider network projects including leading the work supporting CMS with the development and maintenance of Medicare Advantage network adequacy criteria.
Previously, Charlie led Booz Allen Hamilton’s CMS policy work including supporting the implementation of the CMS Part D program. He also assisted health plans with the development of growth strategies for the Medicare Advantage market.
Who we serve
Retium Health offers Health Plans/Medicare Advantage Organizations (MAOs) support to develop provider networks that meet CMS network adequacy standards. Under CMS’s Medicare Advantage and Section 1876 Cost Plan Network Adequacy Guidance, “CMS requires that organizations contract with a sufficient number of providers and facilities to ensure that at least 90 percent* of enrollees within a county can access care within specific travel time and distance maximums”.
(*) CMS has changed this criterion for certain county types
Retium Health can help MAOs with
- Initial provider network submissions and service area expansions
- Triennial network adequacy reviews
- CMS Consultation process
- Exception requests
- Consulting services
Why Retium Health
Retium Health is the right partner for your MA organization. Our team of experts brings more than 10 years of direct experience with the development of network adequacy standards for CMS. We bring a nuanced understanding of CMS’s requirements that will help your organization anticipate key challenges to developing compliant networks including the use of effective exception requests.
Based on our experience, MA organizations face several challenges with the network development and review process, including:
- Identifying additional providers when a specialty fails CMS criteria, including recognizing the “closest” providers available.
- Analyzing the CMS provider supply file to identify incorrect office location or incorrect specialty type assigned in the file.
- Reviewing the ACC and Zip Code deficiency reports.
- Appropriately utilizing and preparing exception requests to address CMS concerns.
- Understanding and addressing CMS feedback.
Approach
Retium Health’s approach ensures that your MAO receives comprehensive support for your compliance needs relying on our expertise with CMS’s review process, its data, and decision-making processes. We can support your organization across all stages of the MA provider network submission and review process.
Retium Health is not affiliated with any provider organization and does not engage in contractual relationships with providers (specialties and facilities)