Navigating the Transition to Value-Based Care: A Roadmap for DME Providers

As healthcare evolves, the shift from fee-for-service (FFS) to value-based care (VBC) is reshaping how medical providers operate, and DME providers are no exception.

As healthcare evolves, the shift from fee-for-service (FFS) to value-based care (VBC) is reshaping how medical providers operate, and DME providers are no exception. In this model, patient outcomes—not just the volume of services provided—are the priority, creating new challenges and opportunities for growth. Here, we’ll explore what this shift means for DME providers and how, with expert insights from Karen Lerner, RN, MSN, ATP, CWS, they can successfully adapt and thrive. 

Understanding Value-Based Care 

Value-based care fundamentally changes the healthcare reimbursement landscape by rewarding providers based on the quality of care and patient outcomes, rather than the quantity of services. Unlike the traditional FFS model, where providers are paid per service rendered, VBC requires measurable, positive patient outcomes to justify reimbursement. 

The Centers for Medicare & Medicaid Services (CMS) is a major driver behind this transition, aiming for all Medicare and most Medicaid beneficiaries to participate in some form of VBC by 2030. By 2025, CMS plans to transition 50% of commercial and Medicaid contracts to value-based models, a significant shift that will impact DME providers and push them to prioritize patient outcomes and long-term care quality. 

Challenges and Opportunities for DME Providers 

Transitioning to a VBC model introduces both hurdles and opportunities for DME providers. Here are some common challenges our partners report: 

1. Tracking Outcomes: VBC demands that providers not only deliver quality care but also document and track specific patient outcomes. For many DME providers, this shift from product sales to measurable healthcare results requires new systems and skills. 

1. Communicating with Payers: Navigating discussions with payers and demonstrating measurable value can be challenging. Providers need to show that their services lead to tangible, positive outcomes—a task that requires data, metrics, and effective communication. 

1. Resource Allocation: Making the shift to VBC often involves investing in new resources, whether it’s software for tracking outcomes, training for staff, or developing partnerships with other healthcare providers. 

However, these challenges bring valuable opportunities. Providers who embrace VBC can enhance patient outcomes, improve customer satisfaction, and potentially increase profitability. Success in this model means developing a reputation for effective, quality care—setting your business apart from competitors and building loyalty among patients and payers. 

Key Strategies for Success in Value-Based Care 

To thrive under VBC, DME providers can implement the following strategies: 

1. Track and Report Outcomes 

The emphasis on outcomes under VBC means tracking patient engagement and experience now takes center stage. The more you can provide patient data that is not readily available to the payer and show positive outcomes, the better positioned you will be to earn their business.   

But where does this data come from? Providers might start with Brian Leitten's “Pressure Sores and Pressure Relief Supplies and Equipment: The Expanded Case for Medicare Investment in DME in 2022” which showed that treatment costs increased as CMS forced DME prices down with competitive bidding. Providers should also leverage existing data from regular compliance checks and patient interactions to build a case for their equipment's impact on patient outcomes. In doing so, they should focus on tracking and analyzing key metrics such as patient compliance rates, treatment response, and health improvements like reduced admissions or fewer disease exacerbations. 

2. Reframe Your Value 

In VBC, the role of DME providers shifts from solely supplying equipment to actively contributing to patient care. Providers must change the narrative around their role to reframe it as part of a broader healthcare strategy in the continuum of care. Instead of saying, "This is John’s DME, and I’m here to talk about equipment,” consider saying, “This is the population health division of our company..." This signals to both patients and payers you are committed to value-based care and the holistic well-being of those you serve.   

This more comprehensive approach means highlighting your ability to proactively identify gaps in care impacting patient outcomes. DMEs have the advantage of being regularly in the home and able to see what other healthcare providers might not: the empty pantry shelves indicating nutrition issues, the steep staircase that could lead to a fall. Providers can add value by communicating this and connecting patients with resources that address such unique challenges—from the right medical equipment to community programs, mental health services, or nutritional support. The objective isn’t to solve every problem but to facilitate access to a network of support that can lead to better health outcomes. 

3. Build Partnerships 

Building strong relationships with payers and other healthcare providers like local home health agencies or organizations devoted to specific conditions, can help DMEs show how they can improve outcomes for a range of partners. By collaborating with local care providers, DME providers can deliver more than just equipment—they can demonstrate real, measurable outcomes that support a broader range of healthcare partners. To shift the perception of DME from a cost to a valuable asset, consider engaging payer case managers to highlight the critical role your services play in improving patient outcomes. Be prepared to illustrate how your offerings: 

• Deliver the best long-term outcomes for patients at competitive prices. 

• Reduce readmissions, ER visits, and hospital stays. 

• Achieve high levels of patient satisfaction. 

• Offer streamlined, supportive interactions. 

Additionally, consider expanding partnerships within your community. Engage with local organizations like the ALS Society to showcase how your services benefit individuals with specific health needs. You can also partner with rehabilitation departments in skilled nursing facilities, dialysis centers, and other healthcare organizations to integrate your products into their care models, enhancing patient outcomes across multiple settings. 

The growth of Home Health Agencies (HHAs), which are under increasing pressure from CMS, presents another valuable partnership opportunity. By utilizing remote monitoring programs, DME providers can help HHAs track patient health and potentially reduce costly in-home visits, fostering both improved care and stronger referral relationships. 

The Future of DME in a Value-Based Care Landscape 

As VBC becomes more prevalent, DME providers who adapt to this model will be better positioned for long-term success. By focusing on patient outcomes and establishing themselves as essential players in the continuum of care, providers can differentiate their services, foster stronger payer relationships, and improve patient loyalty. 

The transition to VBC may feel daunting, but it offers DME providers the chance to elevate their role in patient care, impacting health outcomes in meaningful ways. With careful planning, the right metrics, and a shift in mindset, DME providers can transform these challenges into growth opportunities that benefit both their business and the patients they serve. 

Looking for more ways to navigate the changing DME landscape? 

Downloadour complete guide to stay current on other key shifts in the DME industry. 

Contact our sales team by completing the form below to learn how Drive DeVilbiss Healthcare can help you thrive in this transition.