U.S. Rehab leverages outcomes tool to score big contract

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Friday, January 13, 2017

WATERLOO, Iowa – U.S. Rehab has secured a Humana contract for its members for complex rehab and mobility products and services at higher reimbursement rates.

The key: using the Functional Mobility Assessment outcomes tool, or FMA, to show that quality products and services are worth paying more for.

“We didn’t have a contract with Humana and now we have one,” said Greg Packer, president of U.S. Rehab, a division of The VGM Group. “We were able to show them the level of quality of our independent providers and now those providers have access to that business. Those that were not in-network with Humana can become in-network.”

The contract, which carves out complex rehab and mobility products and services from other DME, goes into effect Jan. 1. VGM’s Homelink division will manage the contract, funneling business to participating U.S. Rehab members.

U.S. Rehab’s not ready to release specific data from the FMA, but Packer says it was able to use the outcomes tool to show Humana that “there are indications that a quality ATP and a quality CRT provider reduces wounds in the data set.”

“Overall, it also increases healthy days,” he said. “It has shown that if you catch possible negative effects quickly and you’re able to address them quickly, you can prevent them before there are dramatic readmissions.”

U.S. Rehab secured exclusive rights to the FMA, which measures patient satisfaction with assistive devices like walking aids, prosthetics and wheelchairs, in 2015. After piloting the tool with about 20 members that year, the group rolled it out to all members in 2016.

Packer calls leveraging the FMA to secure a big contract a “very high point in our performance here” at U.S. Rehab.

U.S. Rehab member Jerry Stalls, president and owner of Stalls Medical, a complex rehab provider based in Cary, N.C., agreed, adding that he hopes other payers take note.

“What Humana will see in the months and years to come is the predicted cost savings of supporting features on a chair that prevents more expensive procedures down the road,” he said. “They’ll see it was a good decision and a good investment.”