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Stakeholders take aim

Stakeholders take aim ‘I think an annual compliance requirement would probably be sufficient,’ says AAH’s Laura Williard

WASHINGTON - Industry stakeholders hope a recent meeting will open up a dialogue between Anthem Blue Cross Blue Shield and CPAP providers who have concerns with some of the insurer's requirements.

Of primary concern: Anthem's benefits management company, AIM Specialty Health, requires providers to supply proof of patient compliance quarterly for the first year of treatment and annually thereafter. That frequency level can create access issues, and possible medical complications, for patients, says Laura Williard, senior director of payer relations for AAHomecare, who met recently with representatives of both Anthem and AIM.

“There have been issues with patients waiting a month or two months to get their supplies because they don't have the compliance data,” said Williard.

AAH has recommended doing away with the ongoing compliance requirement for supplies.

“I think an annual compliance would probably be sufficient,” she said.

AIM says its program is in line with industry standards—patients must use their equipment at least four hours a night for 70% of the time within 30 consecutive days in a quarter. It also says its compliance verification information is available in real time, making it easy to obtain.

With half of patients becoming non-compliant with their therapy during the first year, it's important for repeated engagement, says Nicole Munns, RPSGT, sleep solution directorfor AIM.

“To advance long-term treatment compliance beyond the first 90 days, the AIM program supports regular clinical check-ins throughout therapy, including quarterly during year one and then annually,” she said in an email to HME News.“Providers and members actively engaged in managing their health should have no disruptions in support.”

AAHomecare has formed a workgroup comprised of providers and manufacturer representatives to make recommendations for AIM's sleep management policy and will continue to pursue conversations between the two sides.


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