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New business trends for HMEs in 2022 and beyond
The COVID-19 pandemic has forced dramatic changes in healthcare delivery in the US. It has exposed the human and financial costs of the nation’s health inequity. And it has accelerated change — forcing us to shift to virtual health and more care delivery in the home. Yet the infrastructure and forces required to sustain this transformation continue to remain challenged – specifically, outdated payment models to seamlessly support in-home end to end care, disjointed patient (and caregiver) experience as patients navigate across different care settings, and the administrative overhead (aggravated by labor shortage) to solve for these limitations.
The technology revolution pre-COVID was more aggressive than the healthcare industry had an appetite for consuming, leading to lack of adoption – by physicians, payers & patients. COVID, not only mandated technology adoption by both patients and healthcare providers, but it has us challenging antiquated regulatory rules, rethinking prior authorization processes, activating and managing a remote workforce, and investing in technology.
In 2021, the HME industry’s historical challenges of regulations and reimbursement rates were further exacerbated by safety concerns, staff shortages and supply chain issues caused by almost two years of the COVID pandemic. In spite of these challenges, the HME industry has shown incredible resilience and demonstrated its value in the healthcare delivery ecosystem.
The good news is that the HME market is healthy, estimated to by around $56 billion and growing 6% annually – and it’s profitable. It is important to note the patient is paying an increasingly larger percentage of the HME bill. The attractiveness of the market is evidenced by the rapid pace of consolidation, the amount of investment money coming into the space and the success of the publicly traded HMEs.
At the heart of this crisis, the world became more resilient and learned the value of virtual care delivery. Virtual care delivery & in-home care is here to stay and will be the dominating force to drive digital transformation in the payer, health system, pharma, HME, home health and other home-based care providers’ businesses & operating models. Several such game changing market forces are currently in play that are likely to disrupt our industry in 2022 and beyond.
1. New players are creating more competition.
Historically the HME provider landscape was dominated by the traditional full line HME and medical supply companies. Today, new players are creating more competition. An increasing number of equipment manufacturers and distributors are HMEs with direct to patient models. There has been growth in niche players focused on narrow categories of equipment and supplies. There has also been the emergence of virtual HMEs trying to serve patients through telehealth solutions without physical locations and disrupting current referral patterns.
Big retailers are also expanding their presence. Amazon is viewed as the biggest threat by many with their history of using technology to transform markets and the consumer experience leveraging the incredible power of their data capabilities. Amazon sees healthcare as an industry ripe for disruption. AWS is the foundation of their healthcare strategy – store large amounts of data, predict healthcare events and personalize the patient journey.
CVS has been very public about expanding beyond retail and into other areas of healthcare such as HME and many HME products can be found in their new Health Hub locations around the US. And CVS owns one of the largest commercial payers.
Walmart also has the potential to disrupt the HME industry. They have demonstrated their ability to impact markets as they are significant players in the pharmacy, vision care and hearing care markets. In addition, they have incredible reach into rural markets, 90% of Americans live within 10 miles of a Walmart store.
These large retailers have access to large populations of consumers/patients, have large populations of self-insured employees and are increasingly providing healthcare services. Their relentless focus on the consumer/patient experience is vitally important for the HME industry to recognize
2. The consumerization of the HME patient.
Amazon has transformed the consumer experience into a digital experience. Think about the numerous interactions we have with Amazon and almost no interaction with an actual Amazon employee. The digital consumer experience has now moved to healthcare impacting how we manage our prescriptions, book appointments, get appointment reminders, complete paperwork and review our clinical records. COVID has accelerated this trend and as it turns out, this digital experience is very efficient. The proliferation of a digital experience into many areas of healthcare such as pharmacies, physician and dentist offices, therapy monitoring (CPAP, diabetes) has led to the patient accepting this use of technology. The change occurring now is the patient shifting from accepting to expecting a digital experience.
HME patients want an efficient modern digital experience. They have come to expect a digital experience where first contact with providers is with digital communication, not human interaction (i.e. welcome texts, completion of paperwork). Patients want access to product/service descriptions and education materials. They want transparency knowing where they are in the care delivery process (waiting for paperwork, when is driver/therapist arriving, status of bill). Multiple modalities for communication must exist to utilize the most efficient and effective mode of communication (text, email, app notification, automated call and when necessary live phone call). The digital interactions speed up the process, offer efficiencies to the HME operation and improve customer satisfaction. We can all see why this has become good for patients and why patients want to interact with their healthcare providers similarly to how they interact with Amazon.
3. There is a race to coordinate and monitor care in the home.
Payer incentives, both governmental and commercial, are driving more care into the home. For the payers, it’s straightforward. It’s cheaper and reduces cost. Patients and their families would rather experience care in the home than in a skilled nursing facility, institution, or hospital. We are entering a world where multiple providers can be at work in an uncoordinated fashion in the home. Imagine a scenario where a patient has a home health nurse, an oxygen concentrator from an HME, remote patient monitoring for their chronic condition and the payer has a care coordinator performing routine checks with the patient as well. Investment money is fueling existing and new players in this emerging market offering care coordination, hospital discharge management, remote patient monitoring, chronic condition management, and hospital in the home programs by way of devices and related services. Today’s HME needs to find its place in this crowded care coordination space.
So with all of these forces at work – competitive threats from non-traditional consumer savvy market disrupters, the changing expectations of the patient, and the focus on coordination of care in the home, how does an HME protect its patient base, its referral sources and its market share?
4. Leveraging your strengths and capabilities
HMEs need to take stock and leverage what they do well already. They own the physician and hospital discharge relationship and are trusted. HMEs need to leverage their experience caring for patients in the home. Dropping a package off at the door is easy. Making sure the patient is successful with their care in the home is a different story requiring entering the home, assessing the environment, checking equipment, and educating the patient and caregivers to ensure the care will be effective. HME staff have the clinical expertise, product knowledge and experience navigating the payer landscape. The advantage offered by leveraging these capabilities will be short lived. HMEs need to embrace digital transformation.
5. Doubling down on digital transformation
Moving forward, growth will be predicated on lowering costs and improving margins to permit investment in change. Having a broader impact on a larger community versus doing more things to the same number of people will become the epicenter focus of in-home providers. Removing friction in the system is the primary path to lowering cost. This friction will likely increase with the patient’s home becoming the center of care combined with virtual care delivery expectations.
As technology gets smarter and as the financial pressures increase, technological innovation & adoption will be the primary pathway to technology-enabled value-based care. This will allow for better managing populations at the most appropriate site of care. Digital transformation to drive better care experiences, drive instantaneous and digital(omni-channel) interactions and to use data/AI/ML to automate, predict and tailor business processes is becoming critical to the growth of the HME industry. We need to solve for these:
- Rich & longitudinal patient relationships: Every patient is unique; meeting the patient where they are and personalizing their experience with an omni-channel interaction strategy is critical to capture the patient’s loyalty. However, to serve larger populations, the digital transformation should contemplate reducing administrative overhead and employee burn associated with delivering personalized patient experiences. It’s time to up our game on how HMEs interact with their patients by using technology to digitize patient relationships.
- Digital front door capabilities with robust ecommerce platforms: eCommerce needs to be part of the business model and done well. Do not lose your patients’ cash pay business to other providers.
- Improve operational efficiencies through intelligent automation: Implementing data driven workflows that enable you to focus on what is most important while shortening the referral-to-revenue timeline. Outsource functions that are non-core capabilities, difficult to do well and are challenging to staff with the right talent. Free up time and resources to focus on referrals, sales, growing the business and providing great care.
- Becoming predictable and predictive with data capabilities: An HME’s data must be accessible and usable. Reliance on data and analytics is key to accessing operational insights to assess and improve operational efficiency and patient care.
- Standards, tools, and processes to support value-based care models. The tools that demonstrate improved outcomes and value will not only help meet payer demands in the future but the entities providing care coordination.
This is where Brightree comes in.
Reducing administrative burden can be achieved with a digitally efficient, clean & qualified order, optimized supply and equipment delivery, automated reimbursement experience, reduced reliance on employees and easier onboarding, and using data/AI/ML to maximize the volume of patients served and referral sources connected. Brightree is delivering the solutions to navigate these industry dynamics and capitalize on the resulting big opportunities which will support HMEs’ financial health, patient care and sustainability. Our connected care strategy is how we are delivering these solutions – digitally connecting HMEs to their stakeholders while keeping the patient experience at the center of our solutions. And by stakeholders, I am referring to patients, referral sources, family members, payers, care coordinators, vendors, and partners – digitally connecting HME’s to these stakeholders.
There are 4 pillars to Brightree’s connected care strategy.
Patient Centricity. Innovating on tools to provide a comprehensive digital patient experience.
Improving the patient experience in existing Brightree solutions. Offering capabilities for collecting the data necessary for the feedback loop to continually improve patient experience which leads to referral satisfaction and market share protection.
Efficiency. We are investing in better integration of our solutions, user experience, automation, data driven workflows with the goal of increasing productivity.
Data. We are providing solutions to unlock your data, making it available for actionable insights and supporting other initiatives such as digital patient experience and data driven workflows. We offer DaaS solutions and analytic tools to facilitate operational improvements, benchmarking, and other actionable insights.
Leveraging the Brightree ecosystem. We will continue to expand the Brightree ecosystem with new partners and expand integration opportunities to provide HMEs access to complementary and innovative capabilities.
This interconnectedness of Brightree solutions will:
- Create and sustain stickiness and loyalty with patients and referral sources
- Reduce employee burn by making their tasks easier to perform
- Serve larger patient populations by balancing automation with size of workforce
- Facilitate efficient interactions with referral sources, payers, vendors, and partners
- Provide payers the data they the need to approve the care you provide and expedite payment
Connected care helps build the moat around the things you do well. Leveraging our solutions to power your digital transformation will benefit your patients, your staff, your referral sources, partners, and the overall health of your organization.
Let us be your partner in this journey.
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Brightree
Brightree enables out-of-hospital care organizations to improve their business performance and deliver better health outcomes. As an industry-leading cloud-based healthcare IT company, Brightree provides solutions and services for thousands of organizations in home medical equipment and pharmacy, home health, hospice and home infusion. Brightree is a wholly owned subsidiary of ResMed (NYSE: RMD, ASX: RMD). To learn more, visit www.brightree.com and follow @Brightree on X.
Brightree provide solutions to post-acute care providers (HME, DME & pharmacy home infusion).
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