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 is needed to:
- Standardize medical necessity
- Guide appropriate equipment selection
- Ensure the use of in-network suppliers and coordinated claims management and fulfillment
Without it, plans have limited visibility and control over both cost and quality.
A comprehensive DME management program typically includes:
- Care coordination and fulfillment tracking
- Data and analytics to monitor utilization, outcomes and spend
- Digital intake of orders and referrals from clinicians
- Policy aligned to evidence-based guidelines
- Pricing management and reimbursement controls
- Prior authorization and utilization management workflows
- Supplier network management to in-network suppliers
These components work together to manage the full lifecycle from order through delivery and payment.
DME Navigator introduces structure, control and automation at the point of order that results in more predictable spend and reduced variation. It helps to:
- Apply coverage rules in real time to ensure appropriate utilization
- Guide selection to the right equipment and level of care
- Direct orders to contracted, cost-effective suppliers
- Reduce leakage from out-of-network or non-preferred vendors
- Prevent over ordering, duplication and unnecessary upgrades
- Support consistent experiences across markets
DME Navigator aims to improve the member experience by simplifying and accelerating access to equipment. This includes:
- Coordinating fulfillment with reliable suppliers
- Helping ensure members receive clinically appropriate equipment the first time
- Helping reduce delays through streamlined intake and automated decisioning with clinician oversight
- Supporting transparency into order status and delivery expectations
The result is faster access, fewer disruptions and better overall satisfaction.
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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- 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.