Cards on the Table

Concern, puzzlement, dismay and outright anger are all part of the range of reactions and emotions being expressed by optical retailers and eyecare professionals toward the topic of managed vision care and the currently roiling insurance landscape.

The so-significant portion of the prescription optical business in the U.S. market today driven by managed vision care patients makes the subject a galvanizing one for providers and suppliers, too.

Always, at this time of year, plan programs and requirements for this open enrollment period bring new initiatives, projects, rules and reimbursement shifts that mean new procedures, new protocols and new pricing for providers.

A range of trends have already been transforming delivery systems and insurance risk as the population ages and health care costs in general have skyrocketed across the board for most patients, employers and government agencies. For 2014, of course, this is even more pronounced. The Affordable Healthcare Act’s arrival, and its seriously rocky start have exacerbated doctors’ and patients’ concerns. But, as I wrote in my column back in April, “administrative complexity” is just one aspect of what’s happening now.

Now the changes of all systems, from private insurance to government programs, from employee benefits to the surge in people seeking Medicare and Medicaid, from previously uninsured to lower income people looking for value coverage solutions—all of it is a major restructure of pretty much everything, and vision care is one part of this change.

VM’s story this month attempts to put things into an initial perspective. Naturally, there are elements and aspects of what’s ahead which we will work to explore and monitor as the months develop and individual companies make subsequent moves.

A couple of things seem clear, though:

  • Vision care providers, particularly those who are providing a wider scope of comprehensive eyecare, can be in a good position as the new insurance world focuses on outcomes of patient treatment. As instances of diabetes, glaucoma, AMD and other conditions, identified and treated early via eye exams, are quantified and gathered, this will be a value for eyecare providers and of course for patients’ health.
  • Being proactive about EHR and systems in your practice to manage your involvement, connect with new plan requirements and correctly code to get reimbursements is not a ‘nice to have,’ it’s a ‘must to have.’
  • The pediatric ‘Essential’ benefit will be a good thing—not only for kids but for building the awareness of the importance of vision care and eyewear choices for the whole family. ■