Page 32 - HME Business, April 2019

utor can help link you up with those people.” Sometimes they can even help a good idea grow into a thriving new business.
INNOVATIVE WOUND SOLUTIONS: BREAKING THE CODE
After working for HME distributors for more
than two decades, Trish Mattimoe, RN/CT, was ready to launch her own business specializing
in wound care. It’s an area that requires a lot of custom patient care and interaction with medical providers, and a category with a lot of products.
She’d worked as a consultant for 10 years, then two years ago she struck out on her own and opened Innovative Wound Solutions. It was a
big move, and her distributor, Supreme Medical, played a part in it.
“We had a product from a company called Dukal. It doesn’t have a billing code if you look on the Medicare C schedule, but I remembered from years ago that it was reimbursed and I remember what it was reimbursed. Supreme Medical sold
it to us at a discounted rate and we were able to trial-bill it,” Mattimoe explains. ”It paid exactly as it had in the past, and we were the exclusive provider on that product for quite some time. It was thanks to them allowing us not to have to take the risk and take the hit, but allowing us to crack the code on how to get it billed.”
The support didn’t stop there. “When we opened, in helping us learn how to bill that product ... it opened up a whole new market- place for that company. The manufacturer was so appreciative that they actually made our logo, made our website. There’s a lot of networking among all of us. None of that would have happened without Supreme Medical going the extra mile and allowing us to learn how to crack the code to bill that product.”
Innovative Wound Solutions operates in seven states, has 10 employees and is getting ready
to hire more reps to expand. The company can offer such good service, it just landed an impor- tant new client. “We have been trying to get the biggest insurer in Toledo,” Mattimoe says. “Just this week I got an email that we are getting the contract. That insurance owns this city. Before, we would have to pass-through bill with another provider.”
CAREMAX: DON’T SWEAT
THE DISPOSABLE STUFF
Caremax is a DME pharmacy that sells direct to consumers but also stocks a number of care facili- ties. The company has a physical store in Buena Park, Calif., and serves facilities in Orange County and the Central Valley as well as the Las Vegas, Nev. area. The company is also one of a few that are authorized providers for CalOptima, which
manages Medicaid and Medicare programs. Working with a distributor — McKesson — lets the company supply disposables with
drop-shipping, so Caremax needs fewer vans and drivers and the ones they have can focus on service and upselling.
“It helps going with a drop-ship service, like with McKesson. If we did it all ourselves — with 4,000 customers monthly right now, we have about 10 vehicles of our own — we would need 20 or 25 vehicles to service them all ourselves,” says Richard Maluyo, Caremax vice president and general manager.
Maluyo estimates about 40 percent of Caremax’s sales are drop-shipped, making it a big growth area for the business. The balance of deliveries let the company set itself apart from competitors with personal service.
“We have our own vans and deliveries. We like that white-glove care,” Maluyo says. “We’re able to focus our drivers and the service that we have out to our Medicare customers. A lot of our facility customers need to have specific delivery to their warehouse or storage space. If you are not able to offer that, they will go to the next provider.”
H&J MEDICAL SUPPLIES: SQUEEZING OUT WASTE
H&J Medical Supplies is turning the DME model upside down. CEO Joe McGovern has devel- oped software that helps detect and eliminate systemic waste in the insurance system. He’s building a network that trades cost containment for insurer exclusivity.
“It is technology that is proprietary to us, that is installed into the provider system,” McGovern explains. “If we control the payer, we control the referral. Our way of controlling the payer is eliminating costs from the system in exchange for reimbursement stabilization and contract exclusivity.”
One way that H&J accomplishes that is to handle credentialing for insurers, something he identified as time- and labor-intensive for them. “When we credential our network of providers, we follow all that either CMS or the state puts on them. They have to be accredited by one of the recognized accrediting organizations. We provide that data back, we just do the granular
work for them. If licensure is required we have that on file.”
H&J has three exclusive contracts with regional insurers, earned by reducing the insurers’ DME costs. The system has been able to realize 8 to 12 percent savings for insurers H&J works with, McGovern says.
The H&J software provides a data feedback loop that allows for continuous refinement.
It helps rate neighborhood DMEs based on service and sends referrals to the best neigh- borhood providers. So far the network includes 1,000 DMEs.
On the DME provider end, “Not only is
the software pushing an order to them. They accept it simultaneously connects with billing,” McGovern explains. “If you are an O2 provider and an order comes through my software, the technology has already insurance-verified the consumer because it comes from the insur- ance company. The provider is filling the order, delivering that order and uploading the delivery verification.”
“Best-in-class is all based upon levels of service. The technology pushes an order to the best-in-class provider. They accept or reject that order, we monitor how long each provider takes to get the product to the end user,” McGovern says. McKesson is also helping to provide data to improve the system.
While H&J is based in New York and operates mainly there, McGovern is preparing to expand regionally in the Northeast and looking ahead to going national.
Without a national distributor, H&J was limited to serving a local market. “With McKesson, their distribution capabilities and ability to help us find best-in-class providers in different geographic areas for networks outside our comfort zone,
it’s allowed us to go from local to regional and ultimately nationally. It’s been integral in our growth,” McGovern says. “We anticipate having our first regional contract in place by the end
of the first quarter this year. From a distribution and integration-of-technology perspective and helping us identify best-in-class providers in an area, McKesson will play a huge role.” n
Holly Wagner is a freelance writer covering a variety of industries, including healthcare.
18 HMEBusiness | April 2019 | hme-business.com
Management Solutions | Technology | Products
“It helps going with a drop-ship service, like with McKesson. If we did it all ourselves — with 4,000 customers monthly right now, we have about 10 vehicles of our own — we would need 20 or 25 vehicles to service them all ourselves.”
— Richard Maluyo, Caremax