The Challenge

Support recovery by access, coordination, and management of DME and supplies

When members are sent home without identifying the appropriate resources to support them, such as durable medical equipment (DME), the risk of readmission significantly increases, leading additional costs while compromising the quality of care.

Do you have issues with getting your members the right DME at the right time?

While a relatively small percentage of members require DME; for those that do, it represents 25% of total medical spend.1 These members often have comorbidities, such as diabetes, respiratory and complex mobility, which make it even more critical to focus on delivering high-quality of care. This opens up an opportunity to evaluate and improve existing DME strategies:

  • Leveraging quality providers for timely delivery, set-up and provide ongoing needs to improve member experience and quality of care
  • Ensuring controls are in place to manage current and future costs, across utilization and provider networks,
  • Identifying fraud, waste and abuse

Program Results

0 Member Satisfaction1
0 On Time Starts1
0 Annual Savings1

Our Approach

We cover all categories of DME, including, but not limited to, respiratory, enteral, wound care, orthotics and prosthetics, custom mobility, insulin pumps, continuous glucose monitors, and diabetic supplies. To ensure the best experience for your members, we provide end-to-end coordination, education, and support, from delivery to set-up to ensure we get it right the first time.

Our data-driven utilization management focuses on quality, cost containment, and efficiencies in authorization to ensure on-time starts. Managing our national DME provider network allows us to establish optimal pricing and greater access to equipment and services. Additionally, we have a dedicated team that is focused on fraud, waste, and abuse to ensure appropriate billing and use of services.

CareCentrix maintains a consistent focus on the future of DME with ongoing market evaluation. We continuously evaluate the latest development in durable medical equipment and are able to swiftly adapt programs to changing market conditions, including supply chain challenges.

The CareCentrix Value

Our DME solution can guarantee savings of up to 15% on DME medical spend1 and provide:

  • A quality UM approach that includes clinical management and assessments in areas of technological advances and high costs, including wound care, diabetes, custom mobility, respiratory
  • Ensures medical necessity and clinical appropriateness
  • Centers of Excellence to manage members with complex needs
  • Guaranteed equipment that meets specific quality standards and includes a product warranty
  • Member education, training and ongoing support for provided equipment

Health at Home:
The New Standard of Care

Sources:
1. Spend estimates represent Medicare Advantage, based on CareCentrix experience