Emerging DME Network Models and TPA Activity

Emerging DME Network Models and TPA Activity
June 9, 2026

AAHomecare Intensifies Advocacy Efforts as Network Transitions Raise Questions About Access, Choice, and Provider Sustainability

As health plans continue expanding the use of third-party administrators (TPAs) and intermediary care management models across the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) space, providers are confronting significant operational changes that may affect patient access, care coordination, and long-term business sustainability.

From expanding technology platforms and network management arrangements to sole-source contracting models, the pace of change is accelerating across both Medicare Advantage and Medicaid managed care markets. AAHomecare remains actively engaged with health plans, technology partners, state agencies, and policymakers to ensure beneficiary access and provider concerns remain at the forefront of implementation efforts. Information discussed below reflects current rollout activity and AAHomecare advocacy engagement.

Emerging DME Network Models and TPA Activity

DME NAVIGATOR

Partnership between Optum Health, Parachute Health, and CareCentrix. Providers must contract through CareCentrix and are required to utilize a new suite of services offered by Parachute Health. The automated version of DME Navigator through Parachute Health will require an additional contract beyond the current E-Prescribing contract and is an additional cost. Parachute Health offers an introductory version of this platform at no cost, but providers will have to duplicate entry into their own EHRs and into the DME Navigator software. CareCentrix will be managing the network and the contracts for the DME Navigator model.

BlueCross BlueShield of Tennessee -March 5, 2026, Implementation
Status: Active implementation

The BlueCross BlueShield of Tennessee implementation has provided early insight into issues that can emerge during major network transitions. Patient transitions remain ongoing, and provider feedback has identified concerns surrounding workflow requirements and network composition. Advocacy efforts have helped broaden provider participation opportunities in some cases.

AAH Activity: Meeting with BCBS TN Leadership on a weekly basis, monitoring access and continuity of care.
What providers are watching:

  • Ongoing patient transitions
  • Network participation changes
  • Technology workflow challenges
  • Complex rehab process questions
  • Documentation concerns for transition patients

CareOregon-6/1/2026 Preliminary Implementation
Status: Provider agreements through CareOregon direct extended through 7/31/2026.

AAH Activity: Working with PAMES leadership to obtain meetings with CareOregon.

Molina Healthcare Rollout (CareCentrix/Optum)
Status: Development

Molina Healthcare is also expected to implement a phased rollout strategy involving CareCentrix and Optum across multiple states through 2026. These dates and phases of the states are subject to change based on readiness per Molina National Contracting team.

AAH Activity: Ongoing meetings with Molina national contracting to obtain information on the roll out status and monitoring access to care.

Phase 1-Tentative 7/1/2026

South Carolina, Washington State, Ohio, Illinois

Phase 2-Tentative 8/1/2026

Idaho, Michigan, Nevada, Utah

Phase 3-Tentative 9/1/2026

Arizona, Iowa, Kentucky, New Mexico, Wisconsin

Phase 4-Tentative 10/1/2026

Texas, Massachusetts, California, Georgia, Mississippi, Nebraska

UnitedHealthcare/Synapse Expansion

Synapse Health has a sole source arrangement with United Health Care for some of its Medicare Advantage population throughout the country. Synapse Health is the provider on record but does not provide the services directly. They subcontract with other DME companies to service the network. UnitedHealthcare's Synapse Health arrangement has continued expanding geographically, prompting concerns from providers and clinical stakeholders regarding referral processes, operational burdens, and patient access impacts. Provider and physician feedback has highlighted challenges related to timely equipment access and workflow efficiency.


Current states include:

  • Alabama
  • Georgia
  • Illinois
  • Indiana
  • Kentucky
  • Michigan
  • Mississippi
  • North Carolina
  • Ohio
  • South Carolina
  • Tennessee
  • Virginia
  • West Virginia

June 1, 2026, Recently Implemented States:

  • Arkansas
  • Iowa
  • Kansa
  • Minnesota
  • Missouri
  • Nebraska
  • North Dakota
  • Oklahoma
  • South Dakota
  • Wisconsin

August 1, 2026, Expected Implementations:

  • Florida

September 1, 2026, Expected Implementations:

  • Maine,
  • Massachusetts
  • New Hampshire
  • New Jersey
  • New York
  • Pennsylvania
  • Rhode Island

Provider watch items:

  • Referral workflow changes
  • Hospital discharge delays
  • Provider operational burden
  • Beneficiary choice and access