As Utilization Rises: A Case for Proactive DME Management
Fueled by an aging population and the ongoing shift to home-based care, rising DME utilization creates financial pressure for health plans. By partnering with Verse, leaders take control of their DME strategy and achieve up to 20% lower DME costs.
Published on
March 19, 2026
by
The Verse Medical Team
Your first step in proactive DME management
See how Verse can make a seamless DME experience accessible and affordable for your plan.
From 2019 to 2023, Medicare spending on durable medical equipment (DME) grew 5x faster than overall Medicare spending. Spending on disposable supplies—like syringes, infusion sets, and surgical dressings—grew 9x faster1.
At the same time, V28 risk model changes, Star Rating requirements, and the CMS proposed rule continue to tighten margins. Together, rising DME utilization and downward financial pressure create a compounding challenge for plans.
Tens of millions of Americans rely on DME to manage their health at home
Tens of millions of Americans rely on DME to manage their health, and that number continues to grow as care shifts to the home2. CMS is accelerating this shift by steadily expanding the scope of the DME benefit, including the addition of CGMs and lymphedema compression items in 2021 and 20243. Each expansion is a win for members, and a new cost management challenge for plans.
DME use reduces total cost, but must be managed proactively as utilization increases
The US senior population will nearly double by 2060, and 93% of seniors manage at least one chronic condition5. Clinicians are prescribing more DME to care for these patients, and the economics support it: every dollar Medicare spends on DME can save $11-$29 in direct treatment costs6. DME utilization will continue to grow as home-based care becomes the standard, and plans will need to adopt more proactive management strategies to avoid negative MLR impact.
Most DME networks today aren’t managed proactively
Most plans suffer from the same DME pain points:
Network fragmentation created by hundreds or thousands of supplier contracts
Overutilization driven by fee-for-service incentives
Limited line of sight to savings across 3,500+ DME HCPCS codes
Many plans manage this challenge reactively, without the data, governance, or partnerships needed to drive operational improvements and meaningful savings.
Proactive DME Management for Health Plans
1
Risk Contract
20%
DME Savings
Health plans partner with Verse Medical to remove the unnecessary utilization, unit cost, and administrative overhead plaguing their DME networks.
Plans cap their DME spend in a risk contract and realize up to 20% savings through Verse’s coverage validation technology and targeted unit cost reductions.
Coverage Validation:
Verse’s software validates every DME order against your plan’s coverage rules to eliminate overutilization and wasted spend.
Unit Cost Reductions:
Verse delivers unit cost savings by targeting specific DME categories and codes with market-leading rates.
Your first step in proactive DME management
See how Verse can make a seamless DME experience accessible and affordable for your plan.
Rios Partners. "Medicare and Medicaid Expenditures: Medical Equipment." Health of Health Index, 2024
American Association for Homecare. "Durable Medical Equipment (DME) Represents Approximately 1.5% of Medicare Spending." AAHomecare, 2024.
Centers for Medicare & Medicaid Services. "Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Final Rule (CMS-1738-F, CMS-1687-F and CMS-5531-F)." CMS Newsroom, 2021.
U.S. Census Bureau. "By 2030, All Baby Boomers Will Be Age 65 or Older." America Counts: Stories, 2019.
Watson, Kathleen B., Jennifer L. Wiltz, Kunthea Nhim, Rachel B. Kaufmann, Craig W. Thomas, and Kurt J. Greenlund. "Trends in Multiple Chronic Conditions Among US Adults, By Life Stage, Behavioral Risk Factor Surveillance System, 2013–2023." Preventing Chronic Disease 22 (2025): E15.
Leitten Consulting. "The Case for Medicare Investment in DME." 2021.
