BCBS of Tennessee contract change rattles HME providers

NASHVILLE, Tenn. — Home medical equipment (HME) providers that have served BlueCross BlueShield (BCBS) of Tennessee members for decades say they are shocked and concerned for patients following the insurer’s move to use CareCentrix to manage its commercial, Medicaid and Medicare Advantage plans. 

'No one knows what is going to happen’ 

Provider Charles Satterfield said he received a letter from BCBS of Tennessee in December stating the insurer will begin using CareCentrix’s network for HME-covered services starting March 6. 

"My company has been a BlueCross BlueShield of Tennessee contractor for more than 40 years,” said Satterfield, Pharm.D., chief manager at First Care Health, doing business as Archer’s Total Home Healthcare in Sweetwater, Tenn. “People around here are used to a local provider taking care of them.” 

In the letter, BCBS of Tennessee directs providers interested in continuing to serve affected members to contact CareCentrix at DMEContracting@carecentrix.com. “We hope you’ll choose to continue serving our members by contracting with CareCentrix,” the letter states. 

At press time in early February, however, providers still knew little about the contract outside of what was in the letter. Satterfield said he still didn’t know the rates associated with the contract or whether CareCentrix is accepting providers to its network.  

“No one knows what is going to happen,” he said. 

Thom Harvill, director of payer and government relations for Above and Beyond Medical in Knoxville, Tenn., said providers have also not received reassurance that members in more rural areas, like Appalachia, will have continued service through CareCentrix, which they've heard is trying to narrow its network. 

“Providers are already spending 30 to 40 minutes to get to a patient there,” he said. “A provider in Memphis can’t take care of a patient in Knoxville." 

CareCentrix, Optum tout ‘next-generation’ solution 

When reached for comment, Haley Sofiane, president of CareCentrix, touted DME Navigator, a collaboration between CareCentrix and Optum Insight that is designed to deliver an end-to-end solution for DME benefits management. The platform will leverage a national, regional and local network of more than 3,000 provider locations to ensure quicker access and reliable, on-time delivery of equipment, she said. 

“At CareCentrix, our priority is ensuring members receive the right care, at the right time with exceptional service quality,” she said in a written statement to HME News. “CareCentrix’s nearly 30 years of experience and more than 4 million DME services coordinated annually, we’ve applied everything we’ve learned to create a next-generation solution that is efficient, transparent, member-centric and provider-friendly.” 

CareCentrix declined to discuss specifics related to the BCBS of Tennessee contract, including the size of its network and its reimbursement rates. 

CareCentrix is believed to be leveraging DME Navigator – whose backbone was built by Parachute Health – in not only Tennessee but other states. Paul Root, senior vice president of product at Optum Insight, said the solution addresses “a DME experience that has been fragmented for too long, creating delays and unnecessary burdens for providers and patients.” 

“With DME Navigator, we’re bringing a modern, digital, end-to-end solution that improves transparency, speeds access to equipment and strengthens quality across the entire process,” he said in a written statement to HME News. “By integrating directly into clinical workflows and leveraging a curated national supplier network, we’re making it easier for clinicians to order, easier for suppliers to fulfill, and help members get the equipment they need." 

Harvill said providers in the state plan to educate BCBS of Tennessee that there are tools that already exist and that they’re already using that can achieve the same benefits as DME Navigator. 

Industry goes on the offense 

As the March 6 implementation date approached, one provider in Nashville was reaching out to about 40 patients with complex respiratory conditions who are members of BCBS of Tennessee, uncertain about whether they knew about the change. With so much uncertainty around the CareCentrix contract and their ability to continue serving these patients, the provider is thinking about a Plan B. 

“We’re trying to be proactive,” the provider said. “If they want to stay with us, they have the opportunity to change their managed care organization (MCO) in May. Do we float them for a couple of months until then? This is such a big deal.” 

Industry stakeholders, including ACMESA and AAHomecare, are also engaging with BCBS of Tennessee; TennCare, the state’s Medicaid program; and state legislators to voice concerns about the impact of the contract on patient access and provider networks. 

For providers like Satterfield and Harvill, the situation feels like déjà vu. In 2010, Volunteer State Health Plan, a subsidiary of BCBS of Tennessee and one of three MCOs administering TennCare benefits at the time, contracted with CareCentrix to manage DME claims. 

“It didn’t work that well, and (TennCare) ended up having to go to providers directly (after legislative action),” Satterville said. “It’s been that way since for years – until now.” 

Legislative action may be needed again, Harvill said. 

“There is a push in Tennessee for providers to contact their legislators about this,” he said.