THE FUTURE OF WOUND CARE: ENTERING THE MANAGED CARE ARENA

Glenda J. Motta, RN, MPH, ET

Medical suppliers, particularly those involved in wound care, are entering the arena of managed care. The growth of managed care is the most important force in healthcare today and in the next few years. While negotiating with managed care providers can be complex, many wound care suppliers are successfully competing in this market.

This move toward working with managed care organizations is fueled by the wide variances in Medicare Part B coverage and payment for surgical dressings. In spite of comprehensive documentation, an increasingly high volume of claims is being subjected to review and slow payment. Many medical suppliers are looking beyond Medicare Part B to a broader range of healthcare customers.

Smart suppliers focus on wounds as a disease-specific entity. Understanding the use of products by diagnosis or case type is important. Managed care organizations are interested in products that will make them more efficient and cost effective. This means that they will pay more for a product which eliminates the use of other products, reduces the need for services of healthcare providers, or lowers administrative expenses. Product manufacturers now must focus on features that deliver safety, efficiency, or cost-savings. This tread offers an opportunity to create new products that are more cost effective than the competitors.

Managed care organizations want to contract with providers that have the ability to measure and report clinical progress outcomes and patient satisfaction. The challenge, particularly for wound care suppliers, is to demonstrate cost-effective outcomes. Using past experiences and data collection to demonstrate the clinical benefits of the products that you supply is essential.

To meet the needs of managed care organizations, suppliers are tracking outcomes and reporting back to the case managers on a regular basis. Case managers make medical necessity determinations for their cases, often proactively organize treatment plans, help select home care providers and negotiate prices for their services. Their main objective is to assure that care is provided in the most cost-effective manner. Payers sometimes give case managers the authority to approve payment for services and products not included in the benefits package of a particular insurance plan. Even with the emphasis on cost containment, referral sources such as case managers still want to be able to trust the providers to Shone they direct patients. Establishing good working relationships with these professionals is critical to success.

In order to successfully compete in the managed care market, suppliers must go beyond order taking and product delivery The role now includes patient assessment, either in person or by telephone; preparation of a treatment plan; initiation of serviceslproduct delivery; patient and/or family education; communication with physician and payers; and monitoring patient's needs against the treatment plan. In addition, developing a reputation for good service is critical.

Suppliers who are entering or currently servicing the managed care market use a variety of approaches to establish their credibility. A smart approach is to provide a newsletter for case managers or other managed care clinical personnel. One way is to purchase Wound Tech Times®, a newsletter available exclusively to medical suppliers. It includes up-to-date topics such as outcome, cost, and utilization data; documentation to support reimbursement; educational events and resources; product spotlights; and clinical tidbits on skin and wound care.*

Suppliers are also offering innovative professional services to develop a competitive market edge, such as employing certified clinicians who provide education, personalized instruction, and follow-up with customers.

Success in managed care means designing programs to meet the specific needs of case managers and their patient population. As both Medicare and Medicaid move toward managed care and employers continue to embrace its cost savings approaches, suppliers must proactively face the challenges in order to survive and thrive. The future is managed care and the future is nowl

*Wound Tech Times is a newsletter available for purchase from GM Associates, inc., in Mitchellville, MD. It is sold to medical equipment suppliers who then send it to case managers, nurses, and other healthcare professionals as an educational service. For additional information on purchasing Wound Tech Times, contact Glenda Motta at (301)- 390-4445.