Care coordination is the backbone of effective healthcare delivery, ensuring that all elements of a member’s care plan are aligned and executed without error. However, for many health plans, coordinating care– especially when it involves Durable Medical Equipment (DME)— is a complex task filled with challenges.
DME includes essential items such as:
- wheelchairs
- hospital beds
- oxygen equipment
These medical devices support patients in their daily living and recovery at home. Complicated regulatory requirements, fragmented communication among providers, and delays in care delivery are just a few of the obstacles that need to be addressed to ensure members receive the care they need when they need it.
The Issue with Manual Processes
One of the most persistent challenges in care coordination is the dependency on manual processes, particularly when managing DME orders. These processes are not only time-consuming but also prone to errors and inefficiencies. For instance, one health plan reported that over 75% of prescriptions linger unsigned after 30 days, leading to significant delays in care delivery1. Such delays can have serious consequences, potentially worsening a member’s condition and leading to increased healthcare costs. Manual coordination often requires care managers to navigate a maze of stakeholders—providers, specialists, and a wide range of DME suppliers that are spotty at best and useless at worst, each operating in silos.
Without a unified system, this fragmented approach can result in miscommunication, missed opportunities for timely interventions, and a decline in the overall quality of care. Health plans that rely on outdated processes may find themselves struggling to keep up with the demands of modern healthcare, especially when DME is viewed not as a cost center in need of management, but as a massive resource drain driving provider dissatisfaction.
Traditional home-based care prioritizes the paperwork over the patient, leading to delays
Handling Regulatory and Compliance Challenges
In addition to the operational challenges, health plans must also navigate and comply with a complex web of regulatory and compliance requirements. Ensuring that all necessary documentation is accurate, complete, and readily accessible for audits can often be a burden, especially when handled manually. The time-intensive process of meeting these requirements without automation not only increases the workload for care managers but also increases the risk of non-compliance, which can lead to financial penalties and reputational damage.
For example, manual documentation practices can lead to incomplete or misplaced records, making it hard for health plans to prove compliance during audits, especially in highly regulated environments where non-compliance has serious consequences.
The Need for Reliable DME Partners
An essential aspect of care coordination is ensuring that all partners involved in a member’s care—particularly suppliers—are reliable and efficient. Unreliable suppliers can cause delays in providing necessary equipment or services, further complicating the care coordination process. These delays not only frustrate members but can also lead to poorer health outcomes. Data shows that when reliable, high-value suppliers are engaged, 85% of orders are immediately serviceable2. The quality and reliability of suppliers directly impact the effectiveness of care coordination, making it important for health plans to carefully select and manage these partnerships. However, many health plans, under total cost of care arrangements, are actively trying to eliminate all DME prior authorization and other roadblocks since they are at risk. Although many are in their early stages, some health plans are evaluating their relationships with DME suppliers searching for solutions to achieve better SLAs and customer service.
How Technology Can Help
Given these challenges, the role of technology in transforming care coordination, specifically DME, cannot be overstated. By digitizing and automating key processes, health plans can significantly reduce the time and effort required to manage care, while also improving accuracy and compliance. For instance, automation tools can ensure that DME orders are processed more quickly, documentation is maintained correctly, and compliance is achieved with greater ease. The use of technology can lead to considerable cost savings. Health plans that adopt automation and digital solutions can see up to 15%+ in cost reductions, driven by efficiencies such as automated prior authorization submissions and decision support. These financial benefits, coupled with improved care delivery, make a strong case for the adoption of advanced technology in DME care coordination.
Technology also plays a crucial role in improving communication and collaboration among all stakeholders involved in a member’s care. By providing a unified platform for providers, specialists, and DME suppliers to share information and coordinate efforts, technology creates a more cohesive and efficient care experience. This improved coordination not only improves outcomes but also boosts member satisfaction, as care is delivered more consistently and with fewer delays.
1Data from an internal report indicates that over 75% of prescriptions remained unsigned after 30 days.
2Data from an internal report shows that engaging reliable, high-value suppliers results in 85% of orders being immediately serviceable.
3Data from an internal report shows health plans adopting Tomorrow Health’s solutions can generate 15+% savings for our health plan partners via payment policy optimization, excess utilization reduction, and fee schedule discounts.
