Episode #30: Understanding DME Payer Strategy with Heather Davis, Founder of Visionera

Heather Davis, Founder of Visionera, joins Claim to Fame to break down how DME providers should really be thinking about payer strategy.

What’s Covered?

We talk through common misconceptions about payers, the KPIs that actually matter, and the mindset shifts required for providers entering a more value-based world. Heather also shares her perspective on upcoming regulatory and policy changes and what they mean for the future of DME. We wrap with a quick rapid-fire round and a look at how Visionera is helping providers build smarter, payer-aligned programs.

Podcast Transcription

• Podcast Episode: Understanding DME Payer Strategy
• Guest: Heather Davis, Founder of Visionera
• Hosts: Alex & Wayne (NikoHealth)

Episode Overview

Payer contracting is one of the most misunderstood — and often avoided — areas in the DME industry. In this episode, we sit down with Heather Davis, founder of Visionera, to unpack how payer strategy is evolving, why value-based care is no longer optional, and what DME providers must do now to stay competitive in a landscape increasingly shaped by closed networks and total cost of care.

Heather brings a rare dual perspective. She has spent 20 years in DME leadership roles, including COO positions, and later worked inside a health plan managing a provider contracting team. That inside view changed how she sees the industry — and ultimately led her to launch Visionera.

From DME Executive to Payer Translator

Heather’s career began in DME operations, where she developed payer strategies and built value-based programs long before they were common in the industry. But it was her experience working inside a health plan that proved transformative.

For the first time, she saw how payers actually think. She witnessed the volume of data they analyze, the lens through which they evaluate total cost of care, and the language that resonates in contracting conversations. She realized many DME providers were delivering meaningful clinical value, but failing to communicate it in terms payers understand.

That realization led to Visionera. Today, Heather describes her role as acting “like a translator”, taking what DME companies do operationally and translating it into outcomes, risk alignment, and cost-of-care impact that health plans can recognize and reward.

The Biggest Misconception About Payers

One of the most common misunderstandings in DME, according to Heather, is assuming payers are simply trying to pay less. In reality, payers operate with a broad view of healthcare utilization. They see the full claims picture. They track hospitalizations, comorbidities, risk scores, and long-term cost trends across entire populations.

DME providers, by contrast, often see only the piece directly in front of them. That difference in perspective creates a gap. When providers approach payers focused solely on reimbursement rates or product categories, they miss the opportunity to speak the language that matters most: impact on total cost of care. Heather encourages providers to shift their thinking. Instead of asking how to protect reimbursement, ask how to measurably reduce hospitalizations. Instead of highlighting speed of delivery, highlight reductions in readmissions. Payers think in outputs, not inputs.

Where Most Providers Are Leaving Opportunity on the Table

Improving payer alignment does not require a massive operational overhaul. In fact, Heather believes one of the biggest untapped opportunities lies in something relatively simple: patient education. DME equipment is becoming more technologically advanced. Patients are more medically complex than ever. And yet many providers still rely on minimal education protocols that meet accreditation standards but don’t truly drive outcomes.

Heather has seen measurable improvements in rehospitalization rates, falls, and complication reductions when providers implement even small, focused education programs and track the results.

The key is measurement. Many providers hesitate to measure outcomes out of fear they won’t like what they find. But in Heather’s experience, the results are almost always stronger than expected — and powerful enough to reshape payer conversations.

What Actually Gets a Payer’s Attention

When discussing contracting strategy, Heather emphasizes collaboration over confrontation. The most successful provider-payer partnerships begin with research. What challenges is the health plan facing? Where are their highest-risk populations? What regulatory pressures are they under? From there, the strongest strategies are focused, not broad.

Instead of claiming expertise across every product line, providers should design targeted programs around a specific population and clearly articulate how outcomes will improve. Perhaps the most powerful lever in modern contracting, however, is risk.

Health plans are paid on a per-member-per-month model. They carry financial risk for cost overruns. When a DME provider offers to participate in a risk-sharing model (even modestly) it signals alignment.

A traditional discount may get a nod.
An offer to share risk gets attention.

And importantly, well-designed value-based contracts include upside opportunity. The same percentage that could be lost through performance risk can also be gained through successful outcomes.

The Competitive Bidding Reality

No discussion of payer strategy is complete without acknowledging competitive bidding and network consolidation. Heather sees a clear trend: fewer contracts, fewer providers, and more closed networks — particularly within Medicare Advantage. Unlike traditional Medicare’s “any willing provider” framework, Medicare Advantage plans frequently operate closed networks. Entry requires differentiation. For larger providers, expansion into additional territories may be a strategic necessity. For smaller, local providers, the focus may need to shift toward measurable performance and stronger regional payer relationships to protect revenue.

In both cases, the message from payers is clear: they prefer fewer contracts to manage.

The Shift Toward Value-Based Care

Other healthcare sectors have already transitioned into value-based frameworks. DME has lagged behind. Heather believes the industry now stands at a crossroads. If DME providers do not design value-based programs themselves, payers will eventually impose them. And programs designed without deep understanding of DME operations are unlikely to work well for providers. Value-based care offers an alternative to continuous fee schedule reductions. It creates a narrative beyond reimbursement cuts. It provides a mechanism to demonstrate clinical value.

Most importantly, it aligns the interests of patient, provider, and payer.

The Mindset Shift for New Market Entrants

For those entering DME today, Heather emphasizes differentiation above all else. Health plans often view DME providers as interchangeable product distributors. Breaking through that perception requires demonstrating clinical sophistication and measurable outcomes.

New entrants must ask:
How do we prove we belong in the network?
What makes our outcomes stronger?
How do we communicate that effectively?

Without a clear answer, contracting conversations stall quickly.

Looking Ahead to 2030

Heather predicts the next five years will bring more capitation models, more value-based arrangements, and continued network consolidation. But she does not see this as purely negative.

Innovation creates opportunity. Providers who track outcomes, align with regulatory shifts, and proactively engage payers will not just survive — they will gain market share. Advocacy remains important, she notes. But it cannot be the only strategy. The future belongs to providers who innovate within the system, not just push against it.

The Future of Visionera

Looking forward, Heather sees Visionera continuing to help providers expand into new networks and states while driving broader adoption of value-based care within DME. Beyond contracting wins, she measures success by patient impact. Reduced hospitalizations. Fewer complications. Families spared unnecessary admissions. For Heather, that clinical impact is the ultimate proof that payer strategy, when done correctly, can reshape the industry for the better.