Providers didn’t ask for it, but it’s here

Going into Medtrade in March, I assumed the biggest topics of conversation would be CMS’s next round of competitive bidding and its new moratorium on new supplier numbers.

Those issues were certainly discussed, but by far the most dominant – and most charged – topic on the show floor was the accelerating use of benefits managers and third‑party administrators to manage durable medical equipment products and services.

Just prior to Medtrade, we published a story on BlueCross BlueShield of Tennessee’s plan to use CareCentrix and its DME Navigator platform to manage DME for its commercial, Medicaid and Medicare Advantage members. That news sparked strong reaction.

But it wasn’t until I was at Medtrade that the scope of this shift became clearer. There, we learned of Molina Healthcare’s plans to adopt a similar approach in multiple states, pulling into focus what many providers were already sensing: this model is no longer unusual.

To be clear, none of this is entirely new. Large payers have used benefits management arrangements for years. What has changed is the pace – and the scale – at which more payers are now embracing the model, driven by pressure to control costs, standardize processes and improve efficiency, while at the same time claiming to preserve – or even improve – care.

Another key difference between then and now: technology.

Parachute Health, for example, built the framework behind CareCentrix’s DME Navigator platform. Other benefits managers and third‑party administrators, such as Synapse Health, are similarly leaning into technology to make these models work in ways that may not have been feasible five years ago.

Parachute Health CEO David Gelbard told me his company sees both payers and providers “pushing each other” toward end‑to‑end digital workflows – but that payers, in particular, are accelerating their move to what he calls “digital rails.” Parachute Health positions itself as the enabling partner helping providers meet those expectations.

From a provider perspective, however, the concerns are real—and understandable.

Providers worry about the viability of their businesses. They may not be included in a benefits manager’s network, and even if they are, the reimbursement being offered may not be sustainable. Some may choose not to participate at all. Those who do participate may face new fees for technology, along with the cost – financial and operational – of adopting and adapting to unfamiliar platforms and workflows.

It’s a lot to absorb – and it’s happening fast.

Providers also worry about patients. A payer’s new relationship with a benefits manager may require patients to switch providers. It may direct them to providers farther from home – or, in the view of some clinicians and suppliers, to providers that aren’t as well equipped to meet their needs. For an industry so closely tied to service, relationships and continuity of care, those concerns cut deep.

The kicker: The pressure driving it is coming largely from the top – from payers looking for predictability, leverage and scale in a challenging economic environment. Providers are being asked to adapt to decisions already made, often with limited input.

It raises difficult questions for the industry.

As more payers move in this direction, providers will need to decide if – and how – they engage, what compromises they are willing to make and what lines they are not willing to cross. Acknowledging “this is where things are headed” doesn’t mean abandoning advocacy, but it may require new strategies for navigating an increasingly payer‑driven landscape.

Benefits managers, however, have questions to answer, as well. If they are positioning themselves as partners and problem‑solvers, they will need to prove that their platforms and the provider networks they build truly reduce friction, preserve choice and improve care – not just cut costs.

For providers, the challenge now is not simply resisting change but finding ways to influence what comes next. Whether this model succeeds will depend on whether it can evolve into something that providers and patients can reasonably live with, not just something payers can manage.