The importance of HME advocacy
When patients, providers, distributors and others come together to advocate on behalf of patients, real change is possible. Watch as Maria and her provider join forces, and how McKesson can help.
- Maria Matzik, Patient Advocate
- John Reed, Central Ohio Specialty Care
- Kris Srinivasan, Senior Manager, HME Payer Strategy, McKesson Medical-Surgical
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[Maria] I'm Maria Matzik. I live in Fairborn, Ohio. So my disability is Muscular Dystrophy, more specific, Spinal Muscular Atrophy Type 2. I have had a ventilator...I have been ventilator-dependent since 1986.
[John] My name is John Reed. I work for a holding company called AME Holding, Inc. that has two companies. Advanced Medical Equipment does mobility custom seating. Maria's chair is basically from that side of the business. And then Central Ohio Specialty Care is a business that we started in 2011.
The predominant type of patient we serve is mechanically ventilated, G-tube dependent, just a really long list of supply and equipment needs. ♪ [music] ♪
[Kris] McKesson really got involved in the advocacy front to really advocate for the industry, and so seeing what the patients are really needing, what providers really need, what manufacturers need.
And so to minimize the need for sole source contracting and neural network contracts and really provide an alternative solution that can benefit everybody. So patients have better access to care, providers are more sustainable for the future, manufacturers can be developing new or better, more advanced products, because we know that the reimbursement is going to be strong for the future.
So she uses two ventilators, a primary and a secondary ventilator, so it's hard for some insurance companies to understand why she needs two. The ventilator that she has is 45-minute backup battery so if it fails, she's basically got, you know, less time than it takes for me to drive to work to find a solution, right? And so there are some rules and some payor insurance programs that say that if you can get an EMS here within two hours, you don't need a backup ventilator.
I think for us denials and reimbursement is the biggest thing. In Ohio, we've moved to a managed care model. I don't think managed care really understands long-term disability and living a life with a disability.
In the past three to four years, there's been a number of new models out there for reimbursement payment, specifically sole source contracts and neural network type contracts. And so in those contracts and those situations, you really lose the ability to have a lot of stakeholders involved, and, you know, patients are getting things direct from either a manufacturer or from a payor or specific distributor, so the providers and the patients really lack an access to better products and quality care.
Patients like Maria, she's been able to really be an advocate for patients and advocate for disabilities, and that's all really a demonstration of how this industry has supported her in that effort. I think there's nothing more impactful to a legislator or even at a state Medicaid or Medicare level.
The bonus with Maria was she was verbal, highly intelligent, fiercely motivated, right, and since maybe 2015 we've been stomping the trenches at the State House and with agencies, with the high department of Medicaid, with the managed care plans.
We've done a lot of collaborate discussion on how to make things better for families with disabilities like Maria.
We went to D.C. I talked to legislators in D.C. about the overall need for home care and not necessarily nurses. Mike DeWine, who is the governor today, we met back when he was a state representative. He had us work with his people on issues, but we've been working with Medicaid for 25 years on home care just because of what I experienced and knowing I'm not the only one.
And so really advocating and letting these legislators and these payors really understand what HME does, why they do what they do, and the impact of those cuts is really the focus of advocacy. So McKesson really has a number of tools and resources to really help with the advocacy piece.
We work really closely with AAHomecare at the national and state level, as well as all the state associations across the country to really push a unified communication, a unified value prop to legislators again, to payors, to all those stakeholders who are really involved and understanding how do we better advance this industry, because home care is really where the patients want to be when it comes down to their care on a daily basis.
And so HME providers are one of the key focal points to ensuring that happens.
I think it's really a joint effort and it needs to be. And I got to say I've never seen a company like McKesson do the things they're doing in regards to advocacy and connecting people, because now we have this virtual world where everybody can connect to this.
So McKesson offers, like, the roundtables that they do and just opportunities for people to have their voice. So I think that's going to make a big difference. We might not see it now or tomorrow, but I think a year or so from now, we're going to see a lot of things that change the lives of people for the better, and that's just phenomenal.
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