Focus on what's most profitable
For years, John Allman worked with The Med Group to help members secure managed care contracts. Now Allman is an independent consultant helping HME providers break into managed care markets, and he'll share his best tips in his Medtrade session, "Navigating the Complex World of Managed Care." He gave HME News this preview.
HME News: Do you feel most HME providers have a pretty good understanding of the managed care world?
John Allman: The managed care marketplace and the complexity of payers --PPOs, silent PPOs, companies that establish networks of providers -- become pretty confusing to anybody. It's hard to figure out who is the payer. Most of the payers in the country are small. Just to say, "Run out and get as many managed care contracts you can," is not the solution.
HME: How do the challenges in managed care differ from those in Medicare?
Allman: On the whole, when we need to look up Medicare's rules, we can find them. Managed care is not always a known entity. They may say they will follow Medicare guidelines in medical necessity. But they have different rules in terms of rent-to-purchase, payment terms ...they can write their own rules in many ways.
HME: Why do you believe it's worth the investment of time and resources to pursue managed care markets?
Allman: It's out there. It's part of your world. What will you do if you are in a competitive bidding area and you don't get a contract? If you don't have managed care, what will you do for business?
HME: If attendees come away with one thing from your session, what would you like it to be?
Allman: Whether it's Medicare, Medicaid, managed care or straight retail, we are in a time when we need to focus on what's most profitable. If you're going to play in the managed care arena, it becomes even more critical. HME
Title/company: President, John Allman Consulting
Services provided: Healthcare consulting
Session: "Navigating the Complex World of Managed Care"
Date: Monday, Oct. 24, 2011 / 1:45 PM to 2:45 PM
Contact: 805.239.2462 / email@example.com