Durable Medical Equipment:
A tough challenge.
The challenges facing today's health plans bring a whole new definition to the concept of expectation. Plans must respond to a constantly changing medical landscape, new federal mandates and calls for lower costs yet expanded service from patients and their physicians.
“DME is a unique benefit with its own medical management dynamics: costs have risen without equivalent increases in quality of care or outcomes.”
Managed care plans constantly contend with out-of-control health care trends. At the same time, in order to remain competitive, health plans struggle to implement administrative efficiencies to keep costs as low as possible. This problem is exacerbated by the inherent complexity of Durable Medical Equipment (DME).
Historically, plans have focused on addressing the area of highest cost – physician and hospital services. Consequently, claims systems, staffing, clinical expertise, policies and criteria for medical need determination are very robust for these categories.
DME is quite different because it is supply based (as opposed to service) and there is wide variance in required licensure and accreditation for DME professionals. Plans do not have systems, expertise or processes in place to effectively manage DME and its unique issues, such as rental-to-purchase arrangements, product quality variation, quantity determination, accessories and acquisition based pricing.
Fortunately, a model exists that sets a great precedent for DME benefit management. To address pharmaceutical challenges (also a supply based business), health plans have found that pharmacy benefits management companies can help wade through the complexity and balance patient need with fiscal responsibility. A similar solution for DME, including prosthetics, orthotics and supplies, is now available.
In answer to the growing demand for DME supplies and services, Apropô Benefits Management offers a comprehensive solution to ensure enhanced member satisfaction, improved efficiencies and much-needed cost reduction.
Tough DME challenges call for strong DME solutions
- Cost Control
- Quality Control
- Streamlined Implementation
- Patient Satisfaction
- Physician Confidence
Only Apropô offers a DME Benefits Management program that delivers. >>
