ActivStyle takes stand against low reimbursement

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Wednesday, January 30, 2019

MINNEAPOLIS – With IlliniCare Health holding fast to its drastic cuts to reimbursement for incontinence supplies, ActivStyle has taken a hard a line.

In November, the provider—the state’s largest provider of the supplies—announced it would no longer participate in the payer’s network, something it had done since 2011, says CEO Gayle Devin.

“After fighting the fight, we made the decision that we can’t continue to operate at a loss here,” she said. “We labored long and hard over the decision, but if pulling out will help our cause (so be it).”

IlliniCare, a Medicaid managed care payer, announced across-the-board cuts to DME and supplies of up to 50% in September 2017, effective Jan. 1, 2018. Concessions were made for other product categories, but not incontinence, despite evidence that providing the right products for patients saves money, says Devin.

“If you are proving a low quality product to an incontinence patient, you are going to have increased urinary tract infections, increased instances of incontinent-related dermatitis—all that comes at higher expense to the payer to treat that patient,” she said. “We talked about this with legislators, many of whom said, “let’s wait and see what happens.’”

Devin hopes the withdrawal of the state’s largest provider of incontinence supplies will boost support for House Bill 5930. Introduced in July, the bill would prohibit supply companies from being paid less than 10% below Medicaid fee-for-service rates by MCOs.

While providers have historically been reluctant to drop a payer, more and more are starting to really evaluate whether they accept certain contracts, says Laura Williard, vice president of payer relations for AAHomecare.

It’s a change that needs to happen, she said.

“That’s the message payers need to hear,” she said. “They can’t just keep taking these rates and losing money and they can’t continue to provide care to all of their patients.”