Highmark Blue Cross opens their own DME.

[vic]

Is having a Blue Cross insurance Company opening a DME a good thing ?

Looks like they have the support of the major manufacturers.

What are your thoughts............?

[Sleeprider]

I understand they are opening a store in the Waterfront in Pittsburgh. Sounds like a great idea to give patients an opportunity to see, touch and understand the equipment. It also give Highmark the obvious advantage of cutting out the inefficient DME middle-man. I understand it is based on an Apple Store business model, and will include displays and informed "associates" that can answer questions and demonstrate the equipment. The DMEs don't like it.

[vic]

Be interesting to hear from some Medicare contracted suppliers in the Pittsburgh area.

[Sleeprider]

I posted this link to the Pittsburgh Post Gazette article in October when this was announced. http://www.post-gazette.com/breaking/20 ... 1410290170
and the Trib: http://triblive.com/business/headlines/ ... mark-store

The article mentions other sleep centers and health care centers that have objected to similar experiments in the past. The fight won't be something the public sees. Manufacturer, distributor, retailer relationships are very important in most sectors, and it would not surprise me to see pressure brought against manufacturers that participate with Highmark.

One manufacturer that tried was Murrysville-based Respironics. In 2012, Philips Respironics and Kroger launched a pilot retail partnership — seven Kroger’s pharmacies in Ohio displayed and sold replacement supplies for Respironics’ CPAP devices, masks and tubing accessories. Normally this is seen as products becoming unavailable, and the new retail channel closing. Why do you suppose Lincare recently moved to carry Resmed exclusively over Respironics? I don't know either, but there might be some leverage issues?

But durable medical equipment companies didn’t like being cut out of the equation, said Edward Grandi, the former head of the American Sleep Apnea Association, and the pilot never materialized into a broader retail campaign for Respironics.

“I think there’s probably going to be some durable medical equipment people who are going to be upset,” Mr. Grandi said. “But this shows a commitment on Highmark’s part on addressing the importance of sleep … they’re taking this thing seriously.”

Others take it seriously, too, and sleep care is a crowded market. The Sleep Center of Greater Pittsburgh has 15 locations; LifeLine Center for Sleep Disorders has seven; UPMC has a sleep medicine center in Oakland; and Highmark’s own Allegheny Health Network has its own sleep medicine specialists.

The new Highmark venture may also tread on the feet of Apria Healthcare and Lincare, which both supply respiratory and oxygen therapy equipment. Both have Pittsburgh-area locations.

But challenging existing clinics and suppliers isn’t a bad thing, Mr. Grandi said, and bringing a variety of services and treatments under one roof is a novel approach.

[archangle]

The current DME system is so badly broken that you could probably dispense CPAP machines from the back of a 7-11 and do a better job if you had good management and good remote support. Give everyone a good data capable CPAP, monitor the data properly, present the full information in a good format to the doctor and the patient.

I'm afraid it may follow the model of other captive DME's and just be a way of cost savings and disempowering the patient.

[cathyf]

As we were discussing on the other thread with why there is a market for bricks, the current model has an aspect of the DME's screwing both the patient and the patient's insurance company. At least the Highmark DME won't be screwing Highmark Blue Cross -- at least you would hope so!

[Janknitz]

Kaiser HMO is essentially it's own DME (although Crapria is the supplier), but in Kaiser's case it's a good thing because at least Kaiser recognizes that the better they treat apnea, the more they save in the long term in treating that patient. Untreated apnea leads to much higher medical costs.

Whether your BC will operate that way is the question. More often when an insurer decides to be its own DME, it's for short term profitability. So the insurer is now making a profit off of supplying your DME, and they make MORE profit if they give you cheaper ware. It's an inherent conflict of interest, and in most cases, the short term profit will win over the long term benefit to the patient and the insurer. So don't be surprised if they ONLY supply bricks. The suprise will be if they actually supply full data machines.

[chunkyfrog]

Be interesting to hear from some Medicare contracted suppliers in the Pittsburgh area.

Vic, if you click on my Medicare link, and enter your zip code, then check the box by cpaps and other stuff,
you will get a listing of Medicare DME's near you--the green "M" is next to the contracted providers.

[Guest 2]

Sounds like a good Idea to me, When I shopped online to see what everything would total, it was around $1100 for Machine and mask, But when it came time to get everything though insurance they would charge them $1650.00 because that is what the insurance would cover, Crazy stuff !The system is really broken (sounds the an $800.00 toilet seat to me), (or a $800.00 aspirin)...Broken,Broken!!!

[archangle]

Sounds like a good Idea to me, When I shopped online to see what everything would total, it was around $1100 for Machine and mask, But when it came time to get everything though insurance they would charge them $1650.00 because that is what the insurance would cover, Crazy stuff !The system is really broken (sounds the an $800.00 toilet seat to me), (or a $800.00 aspirin)...Broken,Broken!!!

Far be it from me to defend local DME's, but it does cost more to do local brick and mortar DME with actual face to face support, exchanges, repair service, data monitoring, etc. than it does to sell machines online. Insurance often requires a rental period to start. It costs money do deal with insurance, etc.

[purple]

Hmm. I think a lot of folks here have said truthful things. I raise the specter that a captive DME will eventually become like the VA model of how sleep apnea treatment is done. Some doc writes an order. The patient is sent to an office somewhere that is open a few hours once a week. There they give him the mask they have available, a machine with auto, and maybe not full data. Someone who knows next to nothing about it. shows him the patient the mask goes on (he learned from the pamphlet never given the patient.) Then again, the VA is not always hugely concerned about the long term health of patients. They are overwhelmed with numbers of patients, just as well some of them die.

When captive DME's are more dominant, without competition, then we will see what a really bad DME's are like. Insurance companies will appointment managers with only one goal. Save the insurance company money in the short run.

Patients might be saved by improvements in how machines can function. Then again, we may see masks changed to be an over the counter item. Buy them from blister packs at your local superpharmacy, and pay full price out of pocket.

[Sleeprider]

I think the alternative might be the simple pharmacy model as a complement to the online policy. Filling prescriptions at the allowed cost, with any higher costs for "brand name" or upgrades passed along to the consumer. I see no reason CVS or Rite Aid can't sell CPAP equipment and supplies through the pharmacy. They are good at coordinating with doctors and insurance, and it seems they could easily fill this role with minimal personnel training. Anyone who needs full-service fitting and insurance compliance monitoring can continue with the traditional DME.

[OkyDoky]

I was looking at a forum for Apria techs who were worried about layoffs. They complained about not getting reimbursed enough for time spent for RT time and brought up the CVS idea in a put down way. I'm not sure that it wouldn't work. CVS and Walgreens already gives medication counseling and injections. They could set up the initial teaching and if problems are encountered put the doctor back in the picture.

[chunkyfrog]

In order to provide the services, there would need to be training and compensation for the techs,
--rather than treating them like pieces of meat (patients). --and treat BOTH like human beings! What a concept!