EVANSTON, Ill. – Synapse Health recently added a CTO to its executive team to leverage technology, including a medical rules engine, to streamline the HME ordering process.
The company, which launched in its current form in 2021, currently serves patients in 44 states, processing thousands of orders per day.
“It’s a challenging environment,” said Tony Kilgore, CEO. “From a documentation standpoint, there’s still a lot of manual processes. We started looking at the potential for a technology solution that went beyond just procurement to fulfillment, all the way to billing and collections.”
Kilgore, who has spent his career in DME, doing everything from sales and deliveries to managing operations, including at Apria Healthcare, spoke with HME News recently about the company’s vision to “create forward progress” in the HME industry.
HME News: What is Synapse’s business model?
Tony Kilgore: We are a Medicare-certified DME provider. While we are the provider of record, we also want to partner with a network of high-quality providers because what we’re not is a brick-and-mortar, where we’ve got an extensive network of warehouses and trucks and logistics operations all over the country. We want to access the infrastructure that exists – there’s a lot of good clinicians and teams providing service to patients – so (we’re looking at) subcontracted network partnerships.
HME: What’s the benefit for the contracted providers?
Kilgore: We put the best provider in front of that patient, and they do the set up and make sure all their questions are answered. From there, we serve as the billing and collections entity. We pay on a cash basis so (the providers) have no claims risk, no audit risk. We carry the risk and really streamline the process for our network partners so they can focus on logistics and on patient care, which is what many of them got in the business to do in the first place.
HME: How are you using technology to streamline the process of providing DME?
Kilgore: We have a medical rules engine that is highly customizable, so whether the patient is Medicare or Medicaid, or has commercial insurance – whatever the specifics of their plan are – the intake portal can actually customize the decision trees and make sure that we are attaching all the appropriate documentation for that piece of equipment for that patient. We also are connected to payers on the back end, so we can verify in real time benefits and eligibility.
HME: How are you marketing your value to payers?
Kilgore: Payers want to make sure they are getting good value for the dollars going out the door, but they also care about what they call member experience. They don’t have an adequate measure for what value is being created. Are members being taken care of in a way they feel good about? Often, they don’t hear about anything unless there is a complaint registered, which is obviously not a great way to track outcomes. Our platform gives them an opportunity to see how Theresa’s DME is doing against Apria vs. Lincare. Who’s doing better for oxygen or CPAP or beds and walkers, and why? Is it a delivery issue? Is it a patient training issue? By aggregating the data in one place, there’s tremendous power.