TPAs and paramedics at the Summit

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10/10/2019

I already wrote a story overviewing the HME News Business Summit, but here are some snapshots that, while they landed on the cutting room floor for that story, are still too important not too share.

The return of TPAs

AAHomecare’s Laura Williard hinted at the Summit that we’d be seeing a resurgence of managed care organizations using third party administrators—and not just in Florida.

And voila, just a few weeks later, Sleep Solutions in Michigan sent out an alert to its customers who are BCBS PPO members that the insurer has hired Northwood, a TPA, to manage their HME needs.

As a result of the change, Sleep Solutions warned customers that they may experience access issues (fewer HME providers can now offer products and service to these members) and they may experience reduced services (providers will be forced to re-evaluate what they offer due to reimbursement cuts).

A few years ago in Florida, you’ll recall how the now defunct Univita Health served as a TPA for 10 of the 14 plans participating in the state’s Medicaid managed care program, as well as an HME provider. Univita eventually lost the contracts and filed for bankruptcy, leaving providers in the lurch.

In response to the news in Michigan, Woody O’Neal, a provider in Alabama, commented on twitter: “Just terrible…TPAs, PBMs, all looking to do one thing…profit off the volume of transactions and add nothing to the patient experience. TPAs proliferated in the late 80s on workers compensation cases and now are in the mainstream commercial plans. Just frustrating.”

Stay tuned.

Time to stake your territory

I think everyone agrees that more health care is moving outside the walls of hospitals. How that manifests itself and how that care is paid for are the elephants in the room, but it’s going to happen. It is happening!

At the Summit, Dr. William Zafirau, who leads the Cleveland Clinic’s Center for Connected Care, which brings together all of the clinic’s home and transitional care services, talked about community paramedicine as a new model of care. He talked about how paramedics can treat in place, ideally with increased physician involvement, possibly through telemedicine, to prevent emergency department visits. He also talked about how they’re a good resource for connecting people with community resources.

He also talked about how paramedics may often need some HME—everything from walkers to nebulizers to home blood pressure monitors—to treat people in place.

The optimist in me responded to this with, hey, maybe there’s partnership potential for HME providers here; the pessimist in me responded with, providers need to stake their territory with hospitals for care outside of the hospital before it gets chipped away at by other providers.

Be warned.

Check out a video re-cap of the Summit here.

Check out photos from the Summit here.