AT LIFEPLUS HOME Medical Products in Raymond, N.H., "no" is not the right answer.

It was for a time. April Mason, president of the independent home medical equipment company, well remembers hearing her customer service representatives on the phone saying, "No, you can't have that because your insurance company won't pay for it."

"Like everyone else, we had seen a growth in our managed care business, and I was beginning to notice a philosophical shift in our staff in terms of the customer service," Mason says. "I found that employees were becoming more payer-focused rather than patient-focused."

Rather than thinking of the patients as the customers, the reps were beginning to think of the payers in that role, she says. And that bothered Mason. Lifeplus, which has 10 locations in New Hampshire, Maine and Massachusetts, had always prided itself on customer service. But that appeared to be changing. "We were losing our identity as the company we were always proud of being," Mason says.

She began to ask herself some hard questions: "Why are we here? What is our role? Is our role just to be a gatekeeper for payers-or is our role to meet a patient's needs?" She concluded "that we are not an extension of a managed care organization. Our focus and our priority need to be our patients. End of story. If I don't have any patients, I don't need to provide oxygen to an MCO. What are they going to do with it?"

So about a year ago, Mason visited her company's locations and at each one called a special meeting with employees. "I instructed them to strike the word 'can't' from their vocabulary," she says, adding that she also told them to focus on "how we can fill [the patients'] needs, rather than how we can be a barrier to those needs.

"If there is clearly a need," she says, "there has to be a solution. We call it solution-focused selling; that's what we're doing."

The result of this shift in attitude "has been amazing," she says. Customer service representatives were delighted to get permission to do what they were hired to do-get patients what they need. Sometimes, that means the patients pay for the products themselves. Sometimes, Lifeplus goes to bat for patients with their MCOs, even to the point of getting physicians involved in the discussions.

The reps also educate patients about what home medical products are available. "We have more empowered patients than we had before," Mason says. "And our referral sources appreciate our patient-friendly approach."

And the MCOs? Mason hasn't lost any business there, although she has renegotiated contracts. It has been a battle in some cases, she allows. But she stays focused on educating the MCOs about HME products and relies on the numbers generated by her activity-based costing to bolster her arguments for higher reimbursement. And while some new MCOs in her market haven't yet signed with Lifeplus, she predicts they'll come around.

The bottom line is that sales at Lifeplus are now exceeding goals, Mason says. She can't prove it's because of her just-don't-say-no philosophy, but "wisdom tells me it certainly can't hurt," she says. "If you're focused on the patient, how can you go wrong?"