Modernize durable medical equipment with a member-centric experience
It’s time to reevaluate your Durable Medical Equipment (DME) benefits management strategy. Optum has collaborated with CareCentrix, a leader in health care at home, to offer a comprehensive DME benefits management solution that strengthens member satisfaction outcomes and lowers costs.
Improve your DME workflow by adopting modern practices and leveraging technology. Transition away from paper-based and fax-driven processes, so you can enhance transparency, streamline operations, and provide real-time insights to all stakeholders. This transformation will lead to faster service delivery, more coordinated care and improved member experiences.
Key benefits
Revolutionize your healthcare experiences by enhancing service quality.
EHR-integrated digital ordering platform
Our system showcases vetted, in-network suppliers, ranked based on accessibility, service quality, and cost-effectiveness during service selection.
Integrated evidence-based criteria
Evidence-based criteria is integrated into the ordering platform with streamlined utilization management (UM) processes providing transparency on order decisions at the point of care.
Streamlined digital processes
Enhance patient communication, order tracking, and reliable on-time delivery—minimizing delays as well as incorrect and incomplete orders.
Consistent cost savings
Reduce waste by enforcing coverage through upstream claims editing and pricing, using negotiated, competitive rates.
Reevaluate your DME benefits management strategy
Considering that the number of Americans aged 65 and older is projected to nearly double—from 52 million in 2018 to 95 million by 2060—now is the opportune moment to reevaluate your DME benefits management strategy.
- Enhanced savings: 5–20% PMPY potential savings on average (varies across LOB)2
- Faster service: 80% faster start of care3
- Increased safety: 63% reduction in adverse discharge events related to DME3
DME Navigator FAQ
A comprehensive strategy helps health plans ensure members receive the right equipment, from the right supplier, at the right time. Key strategic objectives include:
- Supporting timely access to medically necessary equipment and supplies
- Promoting consistent application of coverage and medical necessity criteria
- Guiding clinically appropriate equipment selection
- Supporting improved coordination across providers, suppliers, utilization management and claims operations
- Aiming to increase visibility into fulfillment, outcomes, member experience and overall program performance
Without a coordinated strategy, delays, administrative friction, inconsistent processes and limited visibility can negatively impact both member outcomes and satisfaction.
A comprehensive DME management program typically includes:
- Digital intake and processing of clinician orders
- Care coordination and fulfillment tracking
- Evidence-based clinical policies and coverage criteria
- Prior authorization and utilization management workflows
- Pricing and reimbursement management
- Supplier network management and performance monitoring
- Data and analytics to measure utilization, fulfillment, outcomes and member experience
- Point-of-order technology that connects clinicians, suppliers and health plan workflows
Together, these capabilities help health plans create a more seamless experience from prescribing equipment through fulfillment and payment.
DME Navigator helps health plans improve consistency and transparency at the point of order while supporting better member outcomes. The platform can help:
- Apply coverage requirements and clinical policies within provider workflow
- Guide appropriate equipment selection based on clinical need
- Reduce unnecessary utilization, duplicate orders and avoidable upgrades
- Support consistent experiences across markets
DME Navigator is designed to help members obtain needed equipment more quickly and with fewer administrative obstacles. Benefits can include:
- Faster access to medically necessary equipment through digital ordering and streamlined workflows
- Reduced delays associated with fax-based and manual processes
- Improved coordination among providers, suppliers and health plans
- Greater confidence that orders include the documentation needed for timely review and fulfillment
- Better visibility into order status
DME Navigator is designed to reduce administrative burden and create a more guided workflow for providers by:
- Integrating into digital ordering and referral processes
- Minimizing back and forth through real-time decision support
- Providing clear clinical and documentation requirements upfront
- Simplifying prior authorization submission and tracking
This allows providers to focus on patient care while reducing friction in the ordering process.
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Solution suite
Ancillary Benefits Management
Reduce the burden of managing ancillary benefits programs separately across the care continuum. Our solutions leverage an affordability framework to close gaps for better care with lower costs.
- U.S. Census Bureau. The graying of America. 2018.
- CCX/Optum joint analysis of savings potential based on current market data. Potential estimated savings (%) will vary by health plan and actual potential savings will be updated after a specific health plan data run.
- PH data analysis; 2023.