With its reliance on manual, paper-based processes, outdated communication channels, and fragmentation at every turn, healthcare is an industry that lags behind—and durable medical equipment (DME) is no exception.
Delayed access to necessary medical equipment is a common reality for many members, often driven by an outdated and cumbersome prior authorization process that leads to preventable hospital readmissions and poor health outcomes. These processes also result in a poor experience for clinicians and providers and lead to higher costs for health plans.
With the number of Americans aged 65 and older expected to nearly double—from 52 million in 2018 to 95 million by 2060—there’s never been a more critical time for health plans to reevaluate their DME benefits management strategy.1
Cumbersome and Costly: The DME Benefits Management Process
With the rising prevalence of chronic disease and an increase in older, more complex member populations, it’s no surprise that the market continues on an upward trend. In 2024, the U.S. DME market size was valued at nearly $67 billion, and by 2030 it’s expected to reach nearly $93 billion.2
Despite digital transformation in recent years, the DME benefits management process continues to be antiquated and inefficient. Health plans, providers, and members alike face challenges such as:
- Lack of transparency and integration
- Reliance on outdated communication channels such as phone and fax
- Manual processes that are prone to errors and inefficiencies
- Multiple portals for eligibility checks and prior authorizations
- High rates of denials due to missing clinical information
- Issues with equipment delivery that impact outcomes and costs
DME orders that are missing, delayed, or incorrect can delay a member’s discharge from the hospital or post-acute care facility, impact their recovery and treatment adherence, and increase the risk for emergency department (ED) visits and unnecessary readmissions.
These inefficiencies lead to additional administrative burden, delayed reimbursement, a poor member experience, and high costs.
In fact, between $129 to $244 billion annually is wasted on failures of care delivery and coordination and roughly $266 billion of annual healthcare waste is due to administrative complexity.3
At the Forefront of Innovation
While there are many opportunities to improve DME management, CareCentrix is known for leveraging technology to improve DME workflows and delivering 99.7% on-time starts of care.4
Through nearly three decades of experience managing over four million DME services annually, CareCentrix has built a reputation for scale, reliability, and innovation. Our success is driven by a value-based care model, a preferred provider network, and technology-enabled workflows that streamline authorizations and ensure timely, clinically appropriate equipment delivery.
Motivated by a relentless focus on improvement and innovation, our pursuit of even greater impact led to our partnership with Optum—enhancing CareCentrix’s already best-in-class DME solution and unlocking new opportunities to deliver smarter, more connected care.
DME Navigator: Smarter, Faster, and Built for Better Outcomes
Traditional solutions are not enough to solve the current challenges in the DME landscape. Most focus on certain segments of the value chain, such as online ordering, utilization management, or claims editing. Instead of patching together partial fixes or addressing challenges in isolation, a comprehensive strategy can help health plans improve outcomes, enhance the member experience, and better manage costs.
CareCentrix and Optum have redefined DME management with DME Navigator—the only solution that fully integrates end-to-end DME benefits management. This comprehensive solution ensures members receive the right equipment for their unique needs, at the right time, with exceptional service quality and consistent cost savings.
By digitizing the DME ordering process—from product and supplier selection to prior authorization and patient notification of delivery—the solution eliminates inefficiencies, reduces administrative burden, delivers faster and more accurate service, enhances the user-friendly experience for all stakeholders, and drives better overall quality of care and outcomes.
DME Navigator is a single point-of-care ordering platform that features:
- A seamless digital ordering experience with EHR integration and real-time eligibility checks at order initiation
- Digital communication tools that support transparency for members and their care teams from fulfillment to delivery
- Automated electronic prior authorization submissions, leveraging evidence-based clinical criteria to help clinicians make the most informed and clinically appropriate care decisions
- Payment accuracy and identification of waste and abuse through upstream claims editing
- A national network of suppliers curated at the market level by industry experts that provide high-quality, cost-effective equipment and reliable on-time delivery and equipment support
- Savings optimization through claims pricing using competitive network rates
In a recent pilot we conducted to test the ability of suppliers to efficiently enter an authorization upon receiving DME referrals from ordering clinicians through DME Navigator, results showed a significant reduction in requests for additional information to make utilization management decisions.5
Our solution provides coverage across all DME categories and:
- Up to 20% PMPY savings for health plans6
- 97% reduction in ordering and benefit navigation time for clinicians7
- 99.7% on-time starts of care8
- 95% member satisfaction9
As the demand to care for older, more medically complex members increases and more care moves into the home, health plans must prepare for the shift to a comprehensive solution like DME Navigator.
Is your organization ready to more effectively manage your DME spend and elevate the member and clinician experience? Schedule a consultation to explore how DME Navigator can improve outcomes and lower costs.
Sources:
- U.S. Census Bureau, 2018
- Grand View Research, 2024.
- JAMA, 2019.
- 2023 CareCentrix book of business performance data.
- DME Navigator Pilot Data, 2025.
- CareCentrix and Optum joint analysis of savings potential based on current market data. Potential estimated savings (%) will vary by health plan and actual potential savings will be updated based after a specific health plan data run.
- DME Navigator platform data analysis, 2023.
- 2023 CareCentrix book of business performance data.
- DME Navigator platform data analysis, 2023.
EDRC 2323 082025
