WASHINGTON, D.C. (August 18, 2016)—Laura Williard, AAHomecare’s senior director of payer relations, met with representatives of Anthem Blue Cross/Blue Shield and the AIM Sleep Management program to establish a relationship and open a dialogue to represent HME provider interests.
Anthem shared that medical guidelines for the company are established and are consistent across the 14 states they serve, while authorization guidelines are developed at the state level. While Anthem is not able to engage in discussions on specific contract pricing, they expressed interest in value-based purchasing models that AAHomecare is working on with respiratory stakeholders. They also agreed to follow up on specific provider concerns that Williard shared with them and to ongoing meetings for future collaboration.
Williard also met with representatives of the AIM Sleep Management program to share input from AAHomecare’s Sleep Management subgroup. AIM Specialty Health (AIM) is a benefits management company owned by Anthem that specializes in the management of radiology, cardiology, oncology, sleep management and specialty drugs.
One of the main issues addressed with AIM is their requirement that providers supply proof of compliance within 90 days of receiving ongoing supplies. As a result, patients are having to wait to get supplies until compliance data can be obtained, and the additional cost and burden of getting that data falls to the supplier. AAHomecare suggested changes to the policy that would eliminate this policy. However, AIM believes this is an integral part of their sleep management program. AAHomecare discussed potentially looking at the timeframes for this to eliminate some duplication of efforts. AAHomecare also submitted other recommended changes to the sleep management policy. AIM agreed to evaluate these recommendations and to follow up with AAHomecare on these recommendations. They also shared a link to a resource where suppliers can find more information that also includes their sleep clinical guidelines and frequently asked questions.
Thanks to Missy Cross, Christopher Salmen, Beth Guevara, Mark Vages, Jim Duncan, Diana Guth, Peggy Powers and Kathy Murzyn for their work on AAHomecare’s Sleep Management subgroup that developed our recommendations and input for the meeting.
Visit aahomecare.org for more information.
