Medtrade West preview: Position yourself as a partner

PHOENIX – When an HME provider approaches a managed care organization for the first time, 98% of the time they’re going to hear no, says Julie Rhodovi, senior vice president, payor and regulatory relations, RestorixHealth and AMT. Here’s what Rhodovi, who will be hosting a session at Medtrade West on managed care, has to say about winning insurers over and why it’s worth it.  

HME News: What do providers need to keep in mind when it comes to managed care? 

Julie Rhodovi: Contracting with managed care can be a little difficult because the payer tends to throw us all in the same bucket with the assumption that we all provide the same thing. Making them understand what your specialty is, your value proposition and what makes you unique in your offering becomes really important. It not only allows the payer to properly assess the needs of their beneficiaries, but it also categorizes your organization in the right space when it comes to the provider manuals. 

HME: What are your tips for building relationships with insurers? 

Rhodovi: The word relationship becomes really important in that question. They see DMEs as a dime a dozen, so they want to make sure they pick the right ones for their network. So, if you go to a payer saying, “We want to build a relationship with you to do what’s best for your beneficiaries,” that helps the payer see us as a partner.  

HME: Why is it worth the work when payments are typically lower? 

Rhodovi: Look at the growth. Right now, 42% of Medicare beneficiaries are part of a Medicare Advantage Plan and the Congressional Budget Office estimates that number will be at 51% by 2030. Yes, the payment is typically lower, but what does the contribution margin look like? What other items are different? Is there still a prior authorization requirement? Are there appeals? What’s your employee time on a managed care claim versus a traditional Medicare claim?