In brief: UHC’s new capitated arrangement, NCPA’s cyberattack request

MINNEAPOLIS – UnitedHealthcare has entered into a capitated arrangement with Synapse Health for standard DME in Georgia and North Carolina for its Medicare Advantage plan members enrolled in HMO and PPO plans.  

The change, announced on UHC’s website on May 1, is effective Aug. 1. 

DME providers will need to join the Synapse Health network to continue to provide standard DME for these plan members. Synapse Health will reach out to providers with details about joining its network, or providers can contact Synapse at JoinOurNetwork@synapsehealth.com. 

“We understand this is a change to our existing provider network and to the current DME ordering and fulfillment processes,” stated UHC. “However, considering feedback from providers and members, we recognized an opportunity to improve the experience for everyone – ordering physicians, DME suppliers and members.” 

The change will apply to the following standard DME and mail-order supplies: 

• Diabetic supplies 

• Enteral 

• Home ambulatory 

• Hospital beds 

• Insulin therapy 

• Mobility aids 

• Negative pressure wound therapy 

• Ostomy 

• Oxygen 

• Respiratory 

• Respiratory vest 

• Sleep 

• Urological 

• Ventilators 

• Wheelchairs – standard 

• Wound care 

The changes does not apply to complex rehab, orthotics and prosthetics, parenteral nutrition and a handful of other items. 

• HME News spoke with Synapse CEO Tony Kilgore last year about the company’s vision.  

NCPA seeks pause on audits, ahead of cyberattack hearing 

ALEXANDRIA, Va. – Independent pharmacies that are still experiencing operational and financial disruptions related to the Change Healthcare cyberattack made several asks to Congress as part of two separate congressional hearings held May 1. 

In statements for the record, members of the National Community Pharmacists Associations are urging Congress to: 

• Direct plans and pharmacy benefit managers to pause audits; 

• Make pharmacies whole for dispensing medications to patients in good faith throughout the cyberattack; and 

• Prevent punitive actions based on disruptions in care or recordkeeping that resulted from the event.  

“Too much of our health care system is being allowed to flow through gigantic corporate monsters like UnitedHealth; this unfortunate circumstance is proof-positive of that,” says Douglas Hoey, pharmacist and CEO of NCPA. “This entity rakes in a tremendous amount of cash, yet it arbitrarily denies or slow-walks patient care, under-reimburses providers and otherwise makes it difficult to provide health care services, and fails to protect itself and its customers from a catastrophic cyberattack. These broad, debilitating disruptions reiterate independent pharmacy’s view that UnitedHealth Group should not have been allowed to acquire Change Healthcare in the first place and that Congress and other policymakers must finalize and enforce stronger laws to rein in these behemoths as swiftly as possible.” 

The hearings, held by the Senate Finance Committee and the House Energy and Commerce Subcommittee on Oversight and Investigations, featured testimony from Andrew Witty, CEO of UnitedHealth Group, which acquired Change Healthcare in 2022. 

AAHomecare sets stage for fly-in 

WASHINGTON – AAHomecare urges members to reach out to lawmakers over the next two weeks to prime the pump for its upcoming Leadership Legislative Fly-In on May 15, when more than 50 AAHomecare board & council leaders are set to meet with about 140 offices in the House of Representatives and the Senate. Advocates will discuss a range of issues, including Medicare reimbursement policy – specifically, the need to pass 75/25 relief legislation that has moved through House and Senate committees but was not included in recent spending bills. “Calls and emails to health care staff for your senators and representatives over the next two weeks can be a force multiplier for those upcoming in-person meetings set for Capitol Hill,” the association said in a bulletin. The message is simple: Ask your Senators and Representatives to reach out to leadership in their respective chambers in support of extending the 75/25 Medicare blended rates for DME in non-rural areas through 2024 as soon as possible.” 

Aeroflow expands lactation services 

ASHEVILLE, N.C. – Aeroflow Health has expanded its network of lactation consultants and insurance payers, now offering supportive maternal services in all 50 states via telehealth. The services are available through Aeroflow Breastpumps, which also offers speech-language pathologists, registered nurses, doulas, certified perinatal mental health providers, infant sleep specialists and registered dieticians. “As part of Aeroflow Health’s mission to close the gaps in health care, we want to make it easy for new mothers to navigate their pregnancy, postpartum recovery and breastfeeding journey,” said Nicole Peluso, IBCLC, CD, CAHPE, manager of lactation services & perinatal rducation at Aeroflow Breastpumps. “We’re thrilled to bring in more health care professionals to support this stage of motherhood for our patients at Aeroflow Breastpumps.” Aeroflow Breastpumps’ lactation services are covered by insurance, and feature a mix of live online classes, private appointmentss and a catalog of resources and clinical information to support mothers. 

Altra Service Professionals to move to larger location 

OCALA, Fla. – Altra Service Professionals will move its main location to Ocala, Fla., on May 20 to support its growing repair business. This new, larger location at 2140 NE 36th Ave, Unit 400A will better suit the company’s needs, offering more space to accommodate an increased number of units being serviced. “The larger space will allow us to be a better company,” says Cassidy Haug, director of operations for ASP. “We will be able to implement efficiencies through better organization, ultimately speeding up the repair process without sacrificing the quality of repairs.” ASP is an authorized service center for Respironics, CAIRE, Drive DeVilbiss Healthcare and ResMed, servicing respiratory home medical equipment, including oxygen concentrators, POCs, CPAP devices and ventilators. It provides local pickup and delivery to commercial customers in Florida, Georgia, Alabama, New England, New York and New Jersey. Consumers can also visit their offices in Berlin, Conn., or Ocala, Fla., or obtain a pre-paid shipping label to mail in their unit on their website. 

LifeMD, Withings partner on weight management 

NEW YORK and BOSTON – A new strategic partnership designed to advance weight management care will see LifeMD provide its GLP-1 weight-loss patients with advanced in-home health monitoring devices from Withings Health Solutions, including the Body pro 2 scale and the BPM Connect Pro blood pressure monitor. Through the partnership, LifeMD, a provider of virtual primary care services, provides clinicians with near real-time and actionable patient data that can drive compliance, enhance clinical decision-making, encourage preventive health care, and, most importantly, improve long-term outcomes. "Our partnership with Withings supports a key corporate objective of building a significant chronic care management business," said Anthony Puopolo, M.D., president, LifeMD Affiliated P.C.s. "Many patients currently treated by our affiliated medical group for weight management have heart disease, diabetes, or other chronic conditions. Accessible interaction with a virtual provider — combined with diagnostics, remote patient monitoring, and in-home tools like those offered by Withings — can improve patient outcomes and reduce the cost of care for chronic diseases." Body Pro 2 is a cellular body composition scale that measures weight and provides a comprehensive analysis of body composition, including body fat, muscle mass, water percentage and bone mass. BPM Connect Pro offers medically accurate blood pressure monitoring, enabling health care providers to track changes in blood pressure alongside weight-loss progress. 

NSM names Kline to board 

NASHVILLE, Tenn. — National Seating & Mobility has appointed Teresa “Terri” Kline, who most recently served as president and CEO of Health Alliance Plan, which was part of the Henry Ford Health System, to its board of directors. “Terri brings significant transformational experience and depth of knowledge from the managed care world to our board,” said Crispin Teufel, CEO. “A history of board service for growth-driven companies, strategic expertise and passion for mobility solutions make Terri an invaluable resource to our company.” In her role at Health Alliance, Kline led an extensive turnaround of the plan that spanned all lines of business – Medicare, Medicaid, commercial and individual. Previously, she served as chief health care management officer at Health Care Service Corporation (HCSC), where she was responsible for the corporate strategy for managing medical costs and aligning the company’s network contracting, pharmacy, medical and behavioral health. “The mission of NSM aligns with my personal and professional philosophy,” said Kline. “I hope to bring a fresh perspective to the board from not only my experience in the health care industry, but also from my personal experience as a caregiver. I know how powerful the right mobility solutions can be.” Kline also currently serves on the boards of Amedisys and Owens & Minor.  

Ascensia receives iCGM designation for Eversense 

PARSIPPANY, N.J. – Ascensia Diabetes Care and Senseonics Holdings have received an integrated CGM designation from the U.S. Food and Drug Administration. The designation indicates that the Eversense iCGM product can integrate with compatible medical devices, including insulin pumps. “Managing diabetes is all about personal choice and finding the options that best support an individual to live a healthier, less interrupted life,” said Brian Hansen, president of CGM at Ascensia. “For many, one of these choices is to take some of the calculation out of diabetes management by integrating their CGM with an insulin pump as part of an AID system. We are pleased that Eversense has been granted iCGM designation by the FDA, so that people who desire this integration in the future will be able to choose Eversense and access its unique benefits.” The Eversense is an implantable device that lasts six months.