Synapse Health: ‘There’s something in this for everyone’

EVANSTON, Ill. – Synapse Health’s Tony Kilgore hopes his background in DME will offer some reassurance to reluctant providers as the company implements its new capitated agreement with UnitedHealthcare. 

The agreement, for standard DME in Georgia and North Carolina for UHC’s Medicare Advantage plan members enrolled in HMO and PPO plan, was announced May 1 and takes effect Aug.1.   

“We're all from the industry, we've walked in the shoes, we've been in the trucks, we've served patients, and we are simply seeking to simplify some of the things that are most complicated in DME,” said Kilgore, CEO. "We (made a commitment) that until we have a clear-cut value proposition for everybody involved, we had to keep working on the model. I think we got to that point where we felt like there's something in this for everyone.” 

Kilgore spoke with HME News about what the initial reaction to the contract has been and why he thinks providers will come around. 

HME News: How has Synapse’s model evolved to have “something for everyone”? 

Tony Kilgore: Our model is to partner with the health plan as the provider of record. We're taking all of the work upfront in terms of doing the intake, qualifying the patients, collecting all the documentation, collecting any copays, and then sending that equipment referral down to the algorithmically selected downstream DME provider. We own the claims risk and we're paying the following month for that downstream provider. They are not chasing that payment – there's no revenue cycle expense, no bad debt expense, no copay collections, no patient acquisition costs. 

HME: Will Synapse build up its network of DME providers to serve this contract? 

Kilgore: We’re actively reaching out to every provider that is working with the impacted members and introducing the way the model works. We’ve got a pretty robust network in place, but I think there’s an opportunity for us to bring in more folks, with the end goal being to service the members in the least disruptive way possible. 

HME: Initial and unofficial feedback we’re hearing from providers about this is not positive. What are you hearing? 

Kilgore: I get it. Change is hard. But once you get to the place that says change is inevitable, it can be reframed as, it can actually benefit the DME provider long term. The other options out there are geared more toward to the utilization of benefits management through a payer lens – squeezing access, making it harder to get payments, squeezing down on service level agreements – but without us in that partnership role playing the intermediary. Even though there’s change, I think there’s a number of folks that are going to embrace it as they start to see the reduction in complexity and administrative burden. 

HME: The million-dollar question is, what is the reimbursement like and will it work for providers? 

Kilgore: (This is one of) the things we’re spending extra laps on. Everybody that grew up in this space, we all look at a fee schedule and immediately do a percentage of Medicare (calculation). But there’s a lot of unreimbursed cost in the way HME is traditionally reimbursed. But because we’re taking a lot of that burden off, when the astute operators look at it from a unit cost analysis, does it make sense? What we have found is that when you do that, we have built in a relatively healthy margin. It’s a bit of the education process that our team is doing now to get people comfortable. 

HME: Are we going to see more alternative models like this in the future? 

Kilgore: In the conversations I’ve had with payers and big physician groups, there’s enough broken in the current state (of health care) that is really going to drive need for change. If you think about the aging of our population and the need to do better by patients and give them more care at home – all those things point to it has to be a bigger part of the solution. We’ve got to do more to create transparency and efficiency.