With a deadline of 2027 from the Centers for Medicare & Medicaid Services (CMS) for providers to adopt electronic processes, Parachute Health is one of the companies at the forefront of the e-prescribing movement, especially in the home health space.
HomeCare sat down with Parachute Health CEO David Gelbar to discuss his work with CMS, the benefits of e-prescribing, transparency in the ordering process and the trends Parachute expects to see moving forward.
HOMECARE: You helped design CMS rules when it comes to requiring providers to adopt electronic processes by 2027. What went into designing those rules, and what did you want to make sure was included for suppliers and patients?
Gelbard: The CMS initiative that a DRLS (Documentation Requirements Lookup Service) documentation requirement lookup service—at the point of care, regardless of what payer the patient has—will create transparency for the clinician and the supplier in determining what clinical data elements were required by the payer. And in creating that transparency, a patient (and their clinician) can know when they're sitting inside the office whether or not that product is going to be covered by their health plan. So now, as it's moved into the 21st Century Cures Act and we're moving toward January 2027, what's really exciting is that in the final rule is an interoperability requirement where electronic medical records (EMRs) and payers will expose through an application programming interface (API) the clinical data and the data required to make a policy decision or a coverage decision. By enabling that data to be transparent, it will accelerate the ordering process, and ultimately tell the patients, the provider and the clinician whether or not that service is going to be covered, denied or requires more medical information.
HC: Part of Parachute’s model is about increasing transparency. Would you say being part of the CMS working group highlights that?
Gelbard: Totally. And I think that's the part around CMS, and the latest partnership we just announced with Optum—whether it's a government payer or whether it's a commercial payer—at the end of the day, we've built a system that works for clinicians and suppliers. But the payers also have their needs that they want to integrate into the ordering process. The biggest thing that we found in a workflow is this authorization process—which is incredibly manual, labor intensive, time intensive—to get authorization and have the transparency (about) whether that patient can be covered for the service. It can take weeks—months in some cases—to get that determination. If there's a way of bringing that into the point of care, it not only streamlines a very laborious process, it also creates transparency for everyone involved: the supplier, the clinician, the patient. I mean, that's the crux of it, and embedded into a process of ordering where it's happening all at once. It's not happening in two different systems; it's happening in one workflow.
HC: What are some of the questions or worries you hear most from providers about transitioning to e-prescribing?
Gelbard: The biggest challenge is—I'll start with what is true. Today we hear from the market, in no uncertain terms, a digital order is more valuable than a fax order. Then the question is, how do you actually approach converting to digital? Because today, it requires a clinician to make a change, and if you just walk into a clinician or just walk to your sales force and say, ‘Hey, let's go try and get more digital orders,’ then it's not a very successful implementation strategy.
When creating change management, especially in technology, it has to be incremental change, and it needs to hit and embed into every operational process at a supplier and at a clinician. So, Parachute has a solution that's comprised of multiple products. One product is for the supplier operations team, one product is for the supplier sales force. One's for the supplier’s management team, one's for supplier compliance and one's for their purchasing team. Each one of them works together to then introduce orders directly to the clinician in a multitude of ways—whether that's new orders, whether that's reorders, whether it's just how you invite them digitally through Parachute. It's how the products all work together.
In an industry that's mostly been fax-based, it's a big jump to now make sure every one of your functions is now operating with product at the forefront that can help drive digital ordering. What we find is that the most successful providers in the market are using all of Parachute’s products to stitch them together to create a digital experience. The best analogy I can give is if you have a brick-and-mortar retail store, and you're opening up an e-commerce website, you don't just set up a website and hope people come, right? There's a very intentional, holistic approach to driving people, to building your e-commerce experience where it's not only as good as the brick and mortar, but hopefully better in many cases. We saw that journey happen in retail over the last 20-30+ years. The moment is now for the medical equipment industry and health care.
… The same jump is happening right now in medical equipment, where e-prescribing could be looked at as an analogy for e-commerce. In the shift to e-prescribing, it's not just hoping people use it, but it's creating a concerted push and effort to get clinicians to adopt e-prescribing. And that's what Parachute uniquely has figured out and built well, which are the tools to enable e-prescribing beyond just, ‘Hey, we have an ordering website.’
HC: Are you surprised that it has taken until a deadline of 2027 to get people to shift to e-prescribing?
Gelbard: Not really. The way government mandates work is they often first look for proof of concepts in the private market that are able to benefit all stakeholders. And in Parachute’s case, I think we've proven, at this point, that it's more valuable for all stakeholders: clinicians, suppliers, patients, payers. You're not seeing the market adoption happen because people want easy prescribing. I think it's given the government more conviction.
And, by the way, we did have a pandemic, … which in some ways actually accelerated digital adoption. It created market validation that digital is more secure, is more efficient, more effective in delivering better patient care and less costly. Now, to pick the ball back up and get running with it and mandating e-prescribing—(it) feels like it'll be great to now see that come to fruition in the same way it happened on the prescription drug side, where a mandate accelerated adoption on the clinician side to utilize a digital product.
HC: Have there been any hurdles you have seen when it comes to making sure everyone is moved to an electronic e-prescribing process by 2027?
Gelbard: I can tell you clinicians are happy about the change—or they welcome the change. They want to have clarity at the point of care, what is covered and not for the products they want to order for their patients. Suppliers are excited about this change because it's less costly to process a digital order, it's faster, it's more efficient.
Now, as we launch with payers, what payers are hoping for is an ability to create that transparency, to enable more streamlined costs and less back-and-forth themselves, but also in a reimbursement model. What is that up front? What is that mechanism up front? If a payer feels that a product may not be medically necessary for a patient, how can they get involved in that process at the point of care? I think that is the ability for all payers to work together for the betterment of patients.
The exciting development with our Optum partnership is them building out how payers could leverage ordering at the point of care to create more transparency into what does ultimately get authorized. In the same way, when I got my coffee this morning, I knew right away that my credit card worked—the insurance card should work in the same way.
HC: Parachute published a 'State of DME' e-prescribing report for 2023. Was there anything in that report that you found important for the industry to know? Was there anything that surprised you?
Gelbard: What I think is most impressive about the way the market is moving is the diversity of clinician types across hospitals, ambulatory, home health, that continue to adopt the platform and order significantly more categories. What started as a mobility ordering product back in 2016 when we first started has now extended to tens of thousands of categories or products. It's amazing how many products are utilized by clinicians in the medical equipment space, the breadth of them to take care of patients. I think that's going to be a very interesting evolution over time, as more types of patients get helped by Parachute. It’s one thing to get the adoption. I think what that report shows is the growth and adoption of digital ordering relative to fax. But I think one of the underlying trends that I review in that report is the breadth of clinician types and types of products and categories ordered to help patients that are dealing with things like COPD, CHS, diabetes, general aging. That's going to be a really interesting data set over time to see not only how to continue reducing costs in this space, but from a quality perspective and from a clinical impact, how are patients getting better from the products that are being ordered and delivered to these patients? Being able to measure that end-to-end will be an exciting thing.
HC: Five million patients is a big number—what does that represent to you and Parachute Health on the path toward reaching more patients? How long did it take to get there?
Gelbard: It's honestly an amazing number for me, because when I started working in the industry, obviously this all started because of one patient—my dad. And to know that half the products in this space usually get ordered, sent to a supplier with missing information, faxed back and forth—which result in delays in patient care, patients not getting what they need—it's amazing to know that half those patients would have had a tough experience without Parachute.
For us, we were started with the patient at the forefront, and (that’s) still true today. To know that we've helped that many patients have transparency to their care, not be stressed out whether that process is going to come, or whether their clinician knew exactly the right requirement. The fact that we've streamlined this critical process to help people feel at ease that their oxygen tanks can arrive, or their wheelchair is going to get there, or hospital beds are going to get there. It's definitely a heartwarming feeling to be able to make that sort of change in this industry.
In terms of the look forward—there are so many things that I still think could be enhanced around this entire experience, and that's what energizes me for the next step ahead, which is not just about digitizing that ordering experience from the clinician to the supplier, it's also now integrating the payer (in order) to automate a lot of those components. To ensure that not only is the order being tracked and information is clear, but the payer is going to actually end up authorizing that service so the supplier is healthier (and) the patient doesn't have to (pay) out of pocket. The clinician has transparency, and the payer has a voice at the table to ensure that that patient is being taken care of.
I think bringing everyone together with transparency in this ecosystem is the only way to increase trust. That when a patient is being taken care of, everyone's on board. I'm excited for the next 5 million, and the next, until any patient in the U.S. who needs a walker or needs to be able to walk or breathe or gets what they need is on top. The mission’s still clear.
