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In response to the current and anticipated changes in health care, a number of the major managed vision care companies have already begun to implement dramatic changes in the way they do business, those with whom they are partnering, and in their relationships with providers as well as with patients. While some of these developments are a direct reaction to the Affordable Care Act, others were already in the works as managed vision care continues evolving. Some of these, impacting providers now and into 2014, are:

Superior Vision Merger with Block Vision

Prior to the pending merger with Block Vision, 99 percent of Superior’s business was direct-to-employer, Rick Corbett, CEO of Superior Vision, told Vision Monday. “This will diversify the marketplace for us, not only in commercial but in medical, Medicare and Medicaid,” he said. “Among the drivers of the merger with Block were the changes that occurred with the ACA, expansion to the uninsured and the modifications made to the Medicare program. Block has relationships with health plans that we did not have. What Block does not have on a national scale is a national provider network. The two of us combined will have the largest provider network in the industry. Medical eye management is another sector of the business that Block is involved in. Block has been involved in the Medicare and Medicaid business, which we believe will be an expanding marketplace as a result of ACA that we did not participate in previously.”

About the pending merger, Kirk Rothrock, president, Superior Vision, said, “The end result is a comprehensive eyecare company with member-centric solutions for the commercial, Medicare and Medicaid markets, encompassing the full range of wellness vision and medical-surgical eyecare programs.”

“We are excited at the opportunity to join forces with a company that so closely matches our philosophy of being focused solely on vision and eye health,” said Andrew Alcorn, president and CEO, Block Vision. “We also serve the relationships with our providers; we are not in the frame business, or the lab business, and we don’t dictate to our doctors.”

Another recent change Superior Vision made was to name Costco Optical to its eyecare provider network last month. “They are a large and popular retailer with a cost structure such that they offer low cost, broad-based membership,” said Corbett. “They will appeal to a percentage of the population that are employed but at a lower end of the spectrum with regard to salaries. We think it’s important to have a variety of choices in our network.”

VSP Introduces Plans, Partnerships

VSP continues to partner with a number of health plans to provide vision coverage for their members. Many of these will be sold within the state health insurance exchanges. “VSP has newly committed partnerships with close to 85 health plans to provide new vision coverage starting Jan. 1, 2014,” Jim McGrann, president of VSP Vision Care, told Vision Monday. These join the 200 health plans already on the books. “In a typical year, VSP normally brings on about 10 to 12 new health plan partnerships. While, 85 committed partnerships are in 32 different states, there are 60 committed partnerships where VSP is providing the pediatric essential health benefits coverage that will be delivered in 25 different states. “

In addition, VSP introduced its Elements Plan last year and its Premier Provider program this year. The Elements Plan was created to provide the pediatric vision care essential health benefit to be sold in partnership with qualified health plans being sold through the exchanges.

The Premier program, introduced this summer, was created to reward loyalty among VSP Global’s providers and patients. VSP providers receive certain benefits when they achieve Premier status, and they do so by achieving specific criteria: 1) Annual sales of $25,000 of Marchon or Altair frames for a single location with two doctors or less, or $50,000 in annual sales of these two VSP-owned frame lines for all other locations. 2) Annual sales of 200 pairs of Unity lenses from the VSP Optics Group. 3) Meeting eye health management criteria and demonstrating preventative care by submitting at least 5 percent of WellVision exam claims with one of four conditions—diabetes, diabetic retinopathy, hypertension and high cholesterol. And 4) installing a retinal imaging machine. VSP members receive benefits from Premier providers such as an extra $20 to spend on Marchon or Altair frames.

Major New Contract and New Lab Approach from EyeMed

This year, EyeMed required its providers to sign a new contract for a new reimbursement model effective Oct. 1, 2013. One key change is that providers now use the Essilor Laboratories of America national network, beginning at first with more than 60 labs that will grow to about 100 labs by December. These will also include specific Essilor Partner Labs and the Walman Optical Company family of businesses. EyeMed is also introducing the choice of Luxottica Lab Services, based in Dallas, and an in-office finishing program option for providers with their own lab. The new EyeMed contract also requires providers to communicate and receive remittance advice and payment electronically.

In May of this year, EyeMed introduced EyePrefer, which offers three levels of coverage. With the EyePrefer Essential plan, employees and/or their dependents receive the basics, including a comprehensive eye exam and complete pair of prescription glasses or contact lens allowance. EyeMed will be debuting a new provider locator that enables members to search for providers in their area on several criteria, including special technology, services or the types of frames they offer.

OptiCare Launches OptiNow with Essilor

OptiCare Managed Vision, in partnership with Essilor Labs of America, has recently launched OptiNow, an online application that allows OptiCare’s providers to place orders through Essilor’s labs while simultaneously filing a claim. OptiNow enables providers to verify member eligibility, file a claim for professional services, and place a lab order all on one page. After the prototype was beta tested and implemented in OptiCare’s Ohio network in October, the company plans to release the application in the rest of its markets later this year. OptiCare created OptiNow to eliminate the need for repetitive data entry, save doctor and staff time, and improve member experience. “OptiNow is another illustration of OptiCare’s continuous quest to increase efficiencies in eyecare administration,” said OptiCare president and CEO, David Lavely.

Davis Adds VP, Re-Launches Website

 
Changes recently implemented by Davis Vision include hiring a senior vice president for exchange development and the launching of a rebranded website. Created specifically to address both public and private exchanges, the new position of senior vice president, exchanges, national accounts and network development, has been filled by Donna Geringer, with over 25 years of managed care experience. Celina Burns, president of Davis Vision, said, “Her role will be pivotal as we leverage our 50-year integrated delivery model and advance our Eyecare Reframed strategy.”

The new “Eyecare Reframed,” introduced earlier this year, is aimed at educating employers and consumers about eyewear and eyecare, “focused on engaging consumers to take a new look at eyecare,” according to the company.

Burns described the new branding and redesigned website as “more direct to consumer and just in the initial stages right now.” According to the company, “The online experience will evolve as the website keeps pace with changes in health care reform.”

UnitedHealthcare Vision Combines Vision and Medical Benefits

UnitedHealthcare has released a white paper written by Linda Chous, OD, chief eyecare officer, and Kim Christopher, vice president of vision strategic solutions, on the subject of “Integrating Eye Care with Disease Management.” The company’s Bridge2Health program does just that, provides integrated vision and medical benefits. A UnitedHealthcare spokesperson told Vision Monday, “We started offering Bridge2Health several years ago, and today we have more than 2,000 companies enrolled in the program.”

WellPoint Introduces Three Initiatives

In April 2013, WellPoint introduced three new initiatives intended to enhance its vision care offerings by “improving the provider/patient relationship,” Jeff Spahr, president, vision services, told Vision Monday. The health benefits company began allowing in-network eyecare providers to view and print patient medical history, included 1-800-CONTACTS as an in-network provider of contact lenses on its vision plans and created a vision care advisory board.

To link medical and vision plans, WellPoint has added a unique “View Medical History” button to its online claims systems that will allow in-network eyecare providers to view and print relevant patient medical history via HIPAA-compliant data transmission. “WellPoint has started a program of sharing some of its members’ prescription medication, diagnosis and laboratory data with vision care providers,” Spahr told Vision Monday. “This is an idea that some might have thought would be difficult to implement. However, the technology that is available today can facilitate this type of data sharing, resulting in better eyecare and medical care.”

WellPoint also created an advisory board to assist in furthering its relationship with its network of eyecare providers. “This new board will be tasked with finding new ways to help address patients’ vision wellness needs, leverage WellPoint’s powerful referral mechanism and improve provider growth and profitability,” said Richard Hom, OD, MPA, FAAO, chair of the new advisory board.

WellPoint also added 1-800-CONTACTS as an in-network option for vision care plan members. “Our members have requested we add an option that would allow them to purchase contact lenses online,” said Spahr.

New Online Initiatives

Two other managed vision care companies—Advantica and MESVision—also introduced websites through which their members can order contact lenses online. The new MESVisionOptics.com site is powered by Arlington Lens Supply, which is owned by National Vision, and Advantica launched its proprietary online contact lens program at AdvanticaContacts.com. ■