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Northwood [Shared]

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Ali Alatas

on 13 October 2016

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Transcript of Northwood [Shared]

Cost-Containment Solutions for Durable Medical Equipment, Prosthetics, Orthotics and Medical Supplies (DMEPOS)
Durable Medical Equipment Benefit Management
Northwood Overview
Founded in 1992
National Coverage - US & Puerto Rico
5,800 Durable Medical Equipment Prosthetic, Orthotic and Medical Supply Provider Locations
Leading, Top-Quality, Accredited Providers – Both Hospital and Independent Based
Durable Medical Equipment Benefit Manager (DBM)
Specialty Benefit Manager
Licensed TPA
1.6 Million Covered Health Plan Lives
1 Million Auto/Work-Comp Lives
Diverse Client Base
Health Plans, Self-funded Groups, Auto Carriers, Workers’ Compensation Carriers and Other Benefit Plan Sponsors
URAC Accredited
Health Utilization Management
Claims Processing
Northwood National Network Coverage
Northwood Environmental Scan
Durable Medical Equipment Benefit Management (DBM) Opportunity
Northwood Durable Medical Equipment Benefit Management (DBM)
Utilization Management: Specialized Wheelchair
Northwood
Value Proposition
Significant Health Plan Benefit Administration Experience
Highly Managed Benefits Model
Utilization Management Program for DMEPOS Services
Payment Policies, Parameters & Controls
Quality Providers
Fee Schedules Designed to Moderate Spending
Administrative Services
Centralized Intake & Member Inquiry
Provider Inquiry & Complaints
Network Claims Adjudication/Payment
Data Reporting/Analyses
Member Satisfaction/Outcome Monitoring
Flexibility to Customize / Tailor Services to Meet Client Needs
Experience
Northwood Capabilities
Products and Services
Single Point of Contact for DMEPOS Services
Comprehensive Services
Provider Network Management
Member Services
Utilization Management
Data/Performance Reporting
and Analysis
Quality and Compliance
Clinical Support
Claims Management
Durable Medical Equipment Benefit Management (DBM)
A study confirmed a 2.6 : 1 return on investment (ROI) with effective DME utilization management.
Durable Medical Equipment
Oxygen and Respiratory
Medical/Surgical Supplies
Prosthetics and Orthotics
Specialized Wheelchairs/Rehab Equipment
Physiotherapy Equipment
Negative Pressure Wound Therapy (NPWT)
Bone Growth Stimulators
Continuous Passive Motion Devices (CPM)
Specialized Items - i.e. Specialty Beds/Mattresses, Airway Clearance Systems, Voice Prostheses, Wigs, Pleurx Drain Kits, PT/INR Monitoring, Continuous Glucose Monitoring
Full Range of Services Under a Typical DMEPOS Benefit Program
Over 5,800 Provider Locations Nationwide
Improved Costs and Utilization on DMEPOS Services
Northwood Clients Benefit from Current Market Trends
Today’s DMEPOS Marketplace – Extremely Competitive
CMS Competitive Bid Process - Identified Significant Opportunities for Improving DMEPOS Reimbursement Rates
Indicates Opportunities for Pricing Improvements
A recent study savings analysis for a prospective client demonstrated the following savings:
This presentation contains confidential information belonging to Northwood, Inc. and distribution beyond Harvard Pilgrim Health Care and its related companies without the permission of Northwood, Inc. is prohibited.
Prepared Especially for
Northwood Current Providers In HPHC Coverage Area
Questions
?
Can they overlap with existing UM programs (or how do they transact) – e.g. we have a UM vendor for sleep testing and for the DME equipment and supplies used after diagnosis?
How do they work with provider networks, can they accommodate plans entire network?
How do they manage against plans reimbursement terms (i.e. rental vs. purchase and various rental periods)?
How do they manage providers that are not pure DME (i.e. hospitals, physicians)?
Who is responsible for requesting the authorization (assuming this is a UM/prior authorization program?
How do they work with COB/dual eligible (e.g. pediatric patients that will eventually be Medicaid and Medicaid has different requirements?
Massachusetts
162 provider locations
Connecticut
48 provider locations
Maine
26 provider locations
New Hampshire
130 provider locations
Full transcript