The relationship builder
WASHINGTON – What’s the key to HME providers thriving in the managed care market? Relationship building, says Laura Williard, who was named last week to a new position at AAHomecare, senior director of payer relations.
“I’ve built relationships with a lot of these payers,” said Williard, currently the senior director of regulatory affairs and contracting for Greensboro, N.C.-based Advanced Home Care. “Once you have those relationships, you can get in and talk with them about collaborative solutions, and it’s easier to work with them.”
Here’s what Williard, who is also involved with the state associations in North Carolina, Georgia and Tennessee, had to say about how she plans to help providers make inroads into this growing, but sometimes elusive, market.
HME News: How has your experience at Advanced Home Care prepared you for this larger role at AAHomecare?
Laura Williard: When I first started at Advanced 24 years ago, we were 65%-70% Medicare, and 30%-35% Medicaid and managed care. We’ve essentially flipped that. Most of that growth has been in Medicare Advantage and Medicaid HMO plans.
HME: What should be the foundation of the relationship between providers and managed care organizations?
Williard: Data. It’s important when you’re dealing with these payers that you show your value and your worth. What are the outcomes and volume of services you provide for their patients. If they’re considering cuts, what are other areas where you can eliminate cost out of providing the service. For example, you can go to them and say, “Let’s talk about the prior authorization process.” How much unnecessary cost is there for the payer and the provider in the operational processes? If you cut the cost of providing the service, it can minimize some of the impact of rate cuts.
HME: What are some of the challenges of the managed care market?
Williard: They often interpret the rules their own way. A recent example of that is a payer denying a detailed description because it just included the HCPCS code and description. The DME MACs have been passing those, but with this payer, it has taken three levels of appeals to get it overturned. The MACs pretty much interpret and audit the same way, so there’s some semblance of consistency. We want some of that to spread out to Medicare Advantage.
HME: What are some of the benefits?
Williard: You have the ability to talk to someone and negotiate with them on a smaller level. With Medicare, you’re fighting a huge battle. With managed care, there can be more flexibility.
HME: What does it say that AAHomecare has developed a position specifically to focus on the managed care market?
Williard: I think it shows a commitment to the industry. It shows it’s looking beyond Medicare. AAHomecare is trying to broaden the resources for providers to make the industry stronger.