Does it take a payer to woo a payer?

Wednesday, December 21, 2011

GLENDALE, Ariz. - Want to find out what managed care payers are looking for in an HME provider? Just ask one, says provider Gary Cox.

Cox, president of Glendale, Ariz.-based All-Med Health Care, hired Gene Dameron, a consultant who has worked for several payers, including United Healthcare, over the past 25 years, to help him win contracts.

"He really understands things from the payer's side and gives us some leverage in creating relationships with the payers that we haven't had before," Cox said.

The No. 1 thing to know about HMOs, Dameron says: They must continually make more and more profits for their shareholders. Understanding that puts a provider in a better position, he said.

That's why Dameron is helping Cox partner with physicians, nursing homes and assisted living facilities to offer HMOs a continuum of care that can save them money.

"HMOs are looking for DME companies they can give national contracts to," said Dameron. "Companies like All-Med can't even get in the door. You have to look at out-of-box ways to serve patients."

Consortiums like these save HMOs money in the long run, Dameron said, because smaller providers pay closer attention to detail and can stop patients' small health issues before they become big, expensive ones.

"That's where HMOs miss the boat," he said. "They don't see their membership as individual people; their responsibility as a business is to be as cost-effective as they can so they can make a profit. If we collaborate, we can reduce the cost of care the right way."

In addition to helping Cox win new contracts, Dameron is also helping him iron out any problems with current contracts. He recently helped sort out a situation where one payer was denying claims based on a mistake on the payer's end.

Although Dameron has only been consulting with All-Med for a few months, Cox is already in negotiations with potential partners and he plans to make presentations to HMOs in early 2012.