As a durable medical equipment (DME) provider, you may offer breast pumps and other lactation and post-natal tools for your clientele, or you may be thinking about expanding into the category. It’s important to understand the kind of support lactating parents need. HomeCare talked with Amanda Minimi, who is director of corporate development at Aeroflow Health, about industry efforts to make breastfeeding available for all. Minimi serves as co-chair of the American Association for HomeCare’s Breastfeeding Coalition, which works with states and health plans to advocate to reduce barriers in access to breastfeeding.
HomeCare: What kind of coverage is there out there for lactation devices or other equipment for new parents? Is there variation between Medicaid coverage and private payers?
Minimi: We are seeing enhancements to breastfeeding benefits. Under the Affordable Care Act (ACA), breastfeeding supplies, support and services should be covered without cost-sharing. Following the ACA’s implementation, breast pumps were initially covered, then replacement parts, and most recently, milk storage bags. Breastfeeding is incredibly important, challenging and costly, so we are thrilled by the progress that has been made.
But, while there has been significant progress, there is still much to do to create equity in access. The ACA provided great benefits for women with commercial insurance or those in states with expanded Medicaid. However, we still see significant gaps in access in states that have not expanded Medicaid. Providing support around breastfeeding is an incredible engagement tool. It is so powerful that Medicaid managed care plans in some states have adopted coverage of breast pumps as a value-added benefit because they recognize its importance.
Also, there are significant variations in Medicaid coverage between states. Some states only require a member to be pregnant to access a breast pump, aligning with ACA benefits. However, other states require a medical necessity such as a complication during birth to obtain access. While most births are healthy, this requirement means many women don’t have access to something as simple as a breast pump, which is necessary to support breastfeeding and returning to work.
Breast pumps can sometimes be accessed through the Special Supplemental Nutricion Program for Women, Infants and Children (WIC), and some states even require a patient to sign a waiver attesting that they did not receive one through WIC. While WIC is an incredible resource, it is not an insurance program. It offers options of formula or a breast pump, but formula is often the preferred choice. We need to find a pathway that provides all Medicaid recipients with access to breast pumps simply for being pregnant. As it stands now, those most in need lack equitable access to support.
HomeCare: A lot of providers may not currently do much with maternal/postpartum equipment—is it worth jumping into if they’re looking to diversify?
Minimi: Candidly, the maternal and postpartum equipment market is challenging. Unlike other product lines, there isn't a recurring revenue stream, which means we must constantly innovate and capture new markets year after year. Besides the ongoing investment needed to attract new patients, we face significant margin compression due to a patient base that is very brand-conscious. While the product line is demanding, I believe the approach of diversifying programs, as Aeroflow Health has done with Aeroflow Breastpumps, is the direction the industry needs to take.
HomeCare: Is there anything providers should know in terms of working with payers to maximize their reimbursement
Minimi: Providers should know that being a strong partner with payers is crucial to maximizing reimbursement. This involves negotiating contracts effectively and demonstrating the value you bring to the table. To achieve higher reimbursement rates, you need to provide a compelling reason for payers to invest more in your services. Building a strong partnership helps create this foundation and ensures mutual benefits for both providers and payers.
HomeCare: There’s a move afoot to make breast pumps and other equipment for new mothers more accessible, especially in terms of working with states to remove sales taxes. Tell us a little bit about some of the efforts or successes on that front.
Minimi: We experienced significant margin compression in the breast pump sector over the years due to reduced reimbursements from payers and increasing costs of goods. Regrettably, these changes have resulted in higher costs for patients. There's a growing trend of patients requesting upgraded breast pumps, which payers and employers are taking note of. Employers are increasingly implementing carve-out processes to ensure their employees have access to breast pump models that best suit their needs.
Breastfeeding is a luxury that not everyone can afford, which is unfortunate. Despite emphasizing the importance of breastfeeding, we often fail to provide adequate support. There's a discrepancy between what we advocate for and what we actually deliver. Our focus on eliminating sales tax aims to help patients maintain access to essential breast pumps. The 5%-7% margin difference is significant, especially considering the rising costs of goods and shipping. Fortunately, we've been successful in obtaining sales tax exemptions for breast pump products.
HomeCare: Are there things DME providers should consider when they’re selecting lactation equipment to carry or suppliers to partner with?
Minimi: When selecting lactation equipment to carry or partners to collaborate with, DME providers should consider several key factors. Firstly, they should recognize that patient demographics vary, and individual preferences play a significant role in their selection of lactation equipment. Therefore, offering a diverse range of high-quality and safe pump options is essential to capture the attention of the audience effectively.
It's important to acknowledge that while sourcing low-cost items may seem appealing, it may not always align with market demands and patient preferences. Understanding that patients may shop around, providers should prioritize offering a variety of options, including those covered by insurance, to meet diverse needs promptly.
When evaluating potential suppliers, longevity in the market and feedback from stakeholders are crucial indicators of reliability. Providers should assess suppliers' track records in areas such as ordering processes, communication and handling disruptions. Ensuring that the supplier's reputation and brand align with the provider's values and standards is essential. Ultimately, the reputation and brand image of both the provider and the supplier collectively contribute to patients' and payers' perceptions of the provider's services.
HomeCare: What can those in homecare do to provide clients with or connect them to lactation support?
Minimi: Providing clients in homecare with access to lactation support remains a critical gap in health care services. Many health plans still do not offer networks of lactation providers, leaving patients to pay out of pocket and submit bills for reimbursement afterward. This situation can be frustrating and disheartening, particularly considering the significant average cost of around $300 per visit. Unfortunately, the lactation benefit is often limited to a privileged few rather than being accessible to the broader population … As a supplier referring patients, it is crucial to thoroughly understand (brand) practices, including billing procedures, customer service standards and industry reputation. These providers essentially become an extension of your brand, so selecting reputable partners is essential in ensuring clients receive the quality care and support they deserve.
