Association leaders use State Summit to align TPA response

WATERLOO, Iowa - VGM’s recent State Leader Summit gave association leaders something they rarely get: A chance to sit in the same room at a moment when the home medical equipment (HME) industry needs a coordinated response to the accelerating shift to third-party administrators (TPAs).

In recent months, insurers in states from Tennessee to Washington state have tapped TPAs to manage their HME benefit.

“Currently, we've got the third-party administrator piece floating through the country – not floating, running briskly through the country,” said Ike Isaacson, senior vice president of government and regulatory relations for VGM Group. “And so, we gave them a forum to talk face to face on the challenges they're seeing, what their members are saying, and what they're doing to advocate on behalf of their members.”

Held ahead of the VGM Heartland Conference, June 8-10, the annual Summit brings together association leaders to share best practices, compare challenges and talk through the issues shaping their associations and membership. This year, the event also included information on how to leverage artificial intelligence (AI) to manage their workload and how to help prepare their members for accreditation surveys.

Support role grows as communication falls short

As insurers increasingly tap into TPA models, associations can fill in information gaps and provide support, says Barbara Stockert, executive director of both the Pacific Association of Medical Equipment Services (PAMES) and the Big Sky Association of Medical Equipment Suppliers (Big Sky AMES).

“A lot of (providers) found out about it second hand,” she said. “There was really no notification and if it was, it probably wasn't done in the best way possible. We're here, not to tell people what to do, but we're here to help them through it.”

Standardizing the industry’s message

In addition to the face-to-face Summit, association leaders have been meeting biweekly with VGM and AAHomecare to develop state-level work plans, including outreach to Medicaid offices, insurance commissioners, governors, lawmakers and other state leaders. The goal is to get everyone on one page.

“AAHomecare has worked on putting together these cool kits, both for associations and providers, to help us standardize the message about why TPAs are harmful, what it's going to do to small DME businesses and why the model is not effective,” said Mary Schafhauser, associate director of the Midwest Association for Medical Equipment Services (MAMES).

Strength in numbers as pressure mounts

Something that will be key in the industry’s efforts: participation from a critical mass of not only associations but also providers themselves.

“We're still dealing with all these other things that are harming the industry,” said Schafhauser, “but as an association, we're only as strong as our member engagement.”

• Related: Payers move deeper into TPA model, according to poll.

Photo courtesy of VGM.