TBO offers contracting expertise as payer challenges intensify

LAS VEGAS – Tactical Back Office (TBO) has added Lauren Barranti to its team, giving smaller home medical equipment (HME) providers access to high-level contracting expertise.

Barranti spent most of her career at Apria Healthcare, where she served as vice president of managed care.

“The nationals have VPs on board to address payer issues, but no one else can afford that,” said Todd Usher, president and founder of TBO. “Now we’re bringing that expertise to smaller businesses.”

TBO says Barranti will leverage its trained back-office teams to support value-based capitation agreements, payer strategy and competitive differentiation analysis.

Bringing national-level expertise to smaller HME providers

Barranti’s impact first became clear through her work with one of TBO’s clients, a respiratory provider based in Modesto, Calif.

“We’re going on personal experience,” said Usher. “They struggled with contracting and credentialing, and she has done wonders.”

Barranti has helped the provider become licensed and credentialed to provide CPAP devices and portable oxygen concentrators in more than 46 states, with a goal of reaching 50 states by June.

“(Payers) are not going to just open up their network because you want to do CPAP and oxygen,” she said. “You have to look for ways to really stand out, so this ability to drop ship for CPAP and oxygen has morphed into a national initiative.”

Industry insights: TPAs, AI and reimbursement pressures

With payer issues peaking across the HME industry, Barranti provides her take on several hot-button topics.

On the rise of third-party administrators (TPAs):

This trend is not new, she says, but new entrants in the market are adding complexity.

“Health plan reliance on portals and third-party care coordination may create barriers to innovation while fragmenting the strength of direct payer relationships,” she said.

On payer use of artificial intelligence (AI):

She supports AI adoption—if used correctly.

“That’s the biggest dilemma right now – how to use it responsibly,” she said. “We’re the ones who hear it when there is a misstep. We’re often able to correct (the situation), but it makes things a little murky.”

On reimbursement challenges:

“Payers use volume to your disadvantage – that’s not necessarily the game for smaller companies,” she said. “It’s incumbent upon us to push back by understanding our profitability on a HCPCS level.”

On reaching the right decision-makers:

“But people will listen if you have something to say about innovation and moving away from antiquated models and strategies,” she said.