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Optum Insight, a division of UnitedHealth Group, recently added a durable medical equipment benefits management service.
For pharmacy benefit managers, the top goal is to help employers manage prescription spending.
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For a DBM, the top goal is simply to help a health plan member finding the right equipment from an honest vendor.
Optum's new DME Navigator hopes to help plan members, or physicians' patients, connect with a reputable supplier that actually has the wheelchair, crutches, breathing support apparatus or other item needed in stock.
Optum is working with CareCentrix, a home care subsidiary of Walgreens Boots Alliance, to provide the new services.
The service uses a system based on an electronic health record to help a care provider or plan order items online and chat with suppliers.
The service system can also help providers or plans determine whether standard clinical evidence supports use of the equipment sought, in an effort to reduce the risk of waste or fraud.
The backdrop
Durable medical equipment cost patients and their plans $62 billion in 2022, and it accounted for 2% of overall spending.
Northwood, a DME supplier, has pointed out that the DME market has suffered from product shortages and concerns about fraud.
For some health plan members facing health problems, doing without the recommended DME may be a nuisance.
For others, lack of equipment such as the right wheelchair or a portable breathing support device may limit their ability to leave their homes and increase isolation, recovery time and an employer's total health care and disability benefits spending.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
