Private pay: MED breaks down barriers to entry

Friday, June 21, 2013

LUBBOCK, Texas – Members of The MED Group now have an “in” with big payers with exclusive provider networks.

Under a new contract, members can provide HME and services to patients of CareCentrix, a provider of home health benefits management services to BlueCrossBlue Shield (BCBS), Aetna and the like, at pre-negotiated rates.

“It is sometimes difficult for a small independent provider to gain access to a large contract,” said Jeff Woodham, senior vice president and general manager at The MED Group. “MED members want to be able to take care of their patients regardless of who the payer is because they have built their reputations around service and it was very hard for them to understand why certain payers would not allow high quality providers to service their patients.”

Members have the ability to opt in or out of all or parts of the contract, which includes oxygen, sleep, DME, mobility and complex rehab equipment and services.

Woodham says there are a number of advantages to opting in, including better rates and better pricing from manufacturer partners, which, in turn, makes it easier to maintain a margin.

“It also gives members the ability to diversify their revenue away from Medicare competitive bidding products,” he said.

Consultant Mary Ellen Conway called the contract “a big win for the little guy.”

“If I had a dollar for every time someone told me they couldn’t get into a managed care contract, I wouldn’t have to work,” said Conway, president of Capital Healthcare Group. “Some haven’t been open since the 80s or 90s.”

The MED Group has 490 members with more than 1,700 locations. Hartford-based CareCentrix’s contracts for HME include BCBS in Tennessee, and BCBS and Aetna in Florida.