CareCentrix bends cost curve

HARTFORD, Conn. - HME providers may view CareCentrix's recently announced partnership with Peformant as just another layer of scrutiny, but a company official says it will go a long way toward moving more care into the home.

CareCentrix announced in late May that it will work with Performant, Medicare's national RAC for DME, home health and hospice, to deploy specialized analytics and algorithms to better identify and decrease waste and fraud.

“The intent here is not for this to be a negative experience,” said Stephen Wogen, the chief growth officer at CareCentrix. “I'm in a lot of conversations with a lot of payers and health systems, and DME is misunderstood. I think the industry is under siege because of historical bad practices, and a lot of that has been cleaned up, but it still needs to overcome a bad rap. We at CareCentrix believe the future of health care is in the home. But for that to be leveraged, home care needs to be accountable and reliable, and providers need to be trusted.”

It's hard to ignore DME and home health as high-risk areas for waste and fraud, Wogen says. Not when CMS says they represent more than $11.4 billion in improper payments each year for Medicare alone.

CareCentrix already has analytics and compliance and special investigative teams in place to detect waste and fraud in its 10,000 provider locations. But the partnership allows the company to combine its existing efforts with Performant's much larger data set, Wogen says.

“We weed out players where we're seeing patterns of fraud, so we believe we have high-performing networks,” he said. “But we believe we can have even higher performing networks.”

The partnership also allows CareCentrix to broaden its existing efforts across post-acute care, Wogen says.

“We can expand beyond the traditional silos of looking at just DME and looking just at home health, and look across settings,” he said. “We can look at post-acute care in its totality.”

Wogen says one byproduct of the partnership with Performant and their combined data crunching may be more prospective vs. retrospective controls, something that an HME industry that's lobbying for more widespread prior authorizations would no doubt welcome.

“That could simplify how we all work,” he said. “We have a prior authorization process in place for a lot of our services today, but what if you were able to examine the process and take away some learnings and ascertain that automatic authorizations in some areas could streamline the process?”

While CareCentrix is a firm believer in home care, it needs to toe the fine line between determining what's necessary and what's not, and the partnership with Performant better equips the company to do that heavy lifting.

“A CPAP mask can keep a patient out of the ER and it can keep comorbidities under control, but does that mean a patient needs five masks a year—not necessarily,” he said. “Providers need to do everything they can to keep a patient compliant; at the same time, supplies continue to increase in cost. By getting the bad players out, it allows DME to be used for what it's supposed to be used for. That's how you bend the cost curve.”