4 trends for ODs to watch in 2015

4 trends for ODs to watch in 2015

AOA's TPC experts advised participants to seek out the ACOs "in their backyard."

2015 brings new opportunities to collaborate with value-based models of care, take on additional pediatric patients and get involved in the AOA's rethink eyecare program aimed at health plans.

Members of the AOA's Third Party Center (TPC) discussed these developments and current market trends during a Dec. 9 webinar, "Town Hall Discussion on Health Care Reform, rethink eyecare and State Issues/Trends." The webinar is now available for AOA members online (member login required).

1. Growth in coordinated care
AOA's TPC members emphasized that accountable care organizations (ACOs) are a model of care ODs should learn more about—and try to join.

2014 saw a big growth spurt for ACOs and other coordinated care models affecting approximately 20 million lives in this country.

As previously reported, OD inclusion in these models is not required, but incentives do exist for ACOs to seek out ODs and the care that they provide. For example, AOA-backed changes in Medicare's 2015 physician fee schedule provide new incentives for certain Medicare ACOs to ensure patients with diabetes receive a comprehensive dilated eye exam from an eye doctor.

TPC experts advised participants to seek out the ACOs "in their backyard" and become acquainted with their medical policy decision-makers, including chief medical officers. ODs can start by setting up a meeting and being prepared to discuss their roles as primary eye care providers who detect and manage disease.

2. A boost from the pediatric benefit
Speakers also addressed specific member concerns about state issues and trends, including the implementation of the ACA's pediatric essential optometric benefit.

Anecdotally, some ODs have seen an uptick in pediatric patients, while others have not seen a notable increase. Several factors may account for this.  Larger up-front, out-of-pockets costs (deductibles, coinsurance and copays) under ACA plans may mean that people might be holding off their visits to ODs.

The quantity of new pediatric patients may also depend on how far along a state is with ACA implementation, said David Redman, O.D., a member of the TPC executive committee. Dr. Redman practices in San Jose, California, where, for example, "We're seeing a big increase in Medicaid pediatric patients. So just hold on; they're coming."

3. Shifts in working with vision plans
AOA members also asked about the increasing difficulty of working with vision plans and their parent companies. For instance, ODs have reported cases where plans have directly competed with them for patients—or forced them to work with inferior labs or products.

TPC experts noted that decisions come down to what an individual practice can tolerate—and whether it makes business sense to continue to contract with a particular vision or health plan.

"Doctors have to advocate for whatever they feel is right" for their practice, advised Stephen Montaquila, O.D., chair of the TPC's Executive Committee.

4. Opportunities with health plans through rethink eyecare
TPC experts also reminded members of a great way to improve collaboration with health plans: rethink eyecare. This AOA market-oriented initiative encourages health care purchasers and payers to integrate eye health and vision care as a core benefit in health plans.

Integrated benefits means the eye exam is a core component of the health benefits package, Dr. Montaquila explained. The result is seamless eye health and vision care: one provider panel administered by the health plan—and less patient confusion.

Opportunities for integration exist not just with health plans but also with employers, benefits advisers, ACOs and other entities, Dr. Montaquila said. "Because these opportunities form locally, we need state-level feedback," so that TPC understands what's happening and can provide help where needed.

December 15, 2014

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