‘New Health Care Influencers’ Are Changing the Delivery of Eyecare and Eyewear

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There’s a “perfect storm” brewing in health care, according to the first speaker in the session titled The New Health Care Influencers.Annmarie Hagan, president and GM of WellPoint’s Specialty Division, covering dental, life, disability and vision, began the discussion about how leaders in the fields of managed care and health care delivery are navigating the changing landscape of health care by expressing her “passion” for the industry. After defining WellPoint’s many roles, including its Anthem and Empire Blue Cross/Blue Shield and Georgia Life divisions, as well as its recent acquisition of 1-800-CONTACTS, she discussed how the corporation is reacting to health care reform and the impending full implementation of the Affordable Care Act over the next 17 months.

“With 30 million more lives covered, 60 million Americans without access to primary care, three weeks wait time for a non-emergency appointment,” along with additional influences, she described this as a “perfect storm” in health care. At the same time, consumers are demanding more access, both to their practitioners as well as to information. “They don’t want to report claims,” but they want information on their smartphones and on social media, they want physicians to be more accessible, and they want their doctors to coach them about staying healthy, she said.

 
WellPoint’s Annmarie Hagan predicted a “perfect storm” was brewing in health care.
Hagan described the ways in which WellPoint is working to achieve this, including offering LiveHealthOnline for HIPAA-protected, 24-7 access to primary care professionals and linking IBM’s Watson, of Jeopardy fame, with “some of our hospitals” for diagnosis and treatment of patients. She concluded, “We believe very strongly at WellPoint that our goal is to touch 125 million Americans over the next several years, integrating health and vision benefits.”

Another “new health care influencer,” David Golden, OD, founder of both the PERC OD alliance and the Eye Home Network, followed Hagan with an explanation of how he’s taking steps to eliminate redundancies and improve efficiencies in health care in general and eyecare specifically. “Regardless of your politics I see an opportunity to create a more cost efficient health care system” following health care reform, he said.

To view video highlights of this session, click here.

Describing “the overall landscape of health care changing rapidly,” he feels that an integrated eyewear model in which ophthalmologists and optometrists working together can create the best equipped practices for patient care. Seeing ODs as gatekeepers, he said that “the turf war between ophthalmologists and optometrists must go away. The real opportunity for eyecare is to increase the role that we have in primary care.”

 
 PERC founder David Golden, OD, called for a more cost efficient health care system.
Using the resources of his PERC alliance of optometrists, combined with access to general ophthalmology and retinal specialists, Golden established a national network of eyecare professionals (ECPs) known as the Eye Home Network to create additional opportunities for all ECPs and to improve patient outcomes while reducing costs. According to Golden, the Eye Home Network Delivery Model’s four keys to success are: 1. Care Coordination—Optometrist as Gatekeeper; 2. Access to Care; 3. Eyecare Professions Performing at the Highest Level of Their Scope of Practice; and 4. Leveraging Technology.

With real world examples in which the Eye Home Network Delivery Model was implemented in a Medicare Advantage Pilot with 997 eligible members in 2012, Golden showed how having primary care physicians refer patients to optometrists rather than to ophthalmologists, as in the traditional model, resulted in a 39 percent savings for 85 percent of the population, reducing costs from $19,020 to $11,600.

With over 100 million eye exams performed by optometrists in the U.S. per year, Golden said that there are legislative changes happening across the country that may affect how they are performed, enabling ODs to take on some of the work traditionally performed by ophthalmologists. He said that we will start to see a surge of opticians performing refractions, with participation in the eyewear distribution model via retail as well as e-commerce. “Optometry will eventually get stretched so thin,” he said, “that you have to evolve or you’re going to get replaced.” He sees the emerging eyecare delivery model as the means to adapt to that changing health care environment.

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