4 trends from the "First 100 days of ACA"

Millions of people have signed up for coverage under the Affordable Care Act (ACA) since January. To serve this growing population, optometrists need to stay on top of marketplace changes and opportunities.

"Report back to us what you're seeing in your state, your region and your community."

That was a key take-home message of "ACA Implementation—The First 100 Days—Implications for ODs," a webinar hosted by the AOA's Third Party Center (TPC) on April 16.  

The webinar helped equip AOA members "with the best roadmap available to understanding the challenges and seizing the opportunities," says Stephen Montaquila, O.D., chair of the TPC's Executive Committee and one of the webinar's presenters.  

He and co-presenter Lendy Pridgen, the TPC's director, touched on a number of marketplace trends that have taken effect:  

1. People are signing up for coverage 
Approximately 11 million people are getting coverage under the ACA's public exchanges, Pridgen says. This includes up to 8 million in private commercial coverage on the exchanges and 3 million in Medicaid. The Congressional Budget Office is projecting a total of 8 million may be enrolled in Medicaid through states' expansion efforts by year's end.  

In private exchanges run by companies such as Aon Hewitt and Health Pass, about a million are currently insured, according to rough estimates. Pridgen says this number could increase to 30 million by 2018, based on a loose projection from industry stakeholders.   

2. Demand for pediatric eye benefit will increase 
The inclusion of a pediatric optometric essential health benefit for eye health and vision coverage under the ACA was a big win for optometry. All health plans-on and off the exchanges-offering individual and small group coverage must include this benefit.  

As a result, demand for children's eye health services will continue to increase as plans add ODs as participating providers. "We're seeing that now," says Dr. Montaquila. In his own practice, he has started to see pediatric patients who are early enrollees of this benefit.   

3. ACOs are proliferating 
Approximately 10 percent of the U.S. population gets care from an accountable care organization (ACO) or a local or regional integrated delivery system involved in ACO-like contracting with commercial payers, Pridgen says. More than 370 ACO entities exist in the Medicare sphere and at least 500 ACO-type entities represent thousands of value-based contractual arrangements in the private market. This is in response to a growing emphasis on value-based care models, he says. 

ODs who want to participate in an ACO should find out what major provider organizations are involved, who their leaders are, and if the organizations include any primary care physicians they know, Pridgen suggests.  

4. The AOA is responding to narrow networks trends
Insurers under the ACA have been trending toward narrower provider networks as a cost-savings move. Some ODs have reported getting shut out of more limited networks. Recently, the AOA has been communicating its concerns to the Centers for Medicare and Medicaid Services over Medicare Advantage plans limiting their networks.

Many ODs and other providers remain uncertain about the law's impact on their practices, says AOA President Mitchell T. Munson, O.D.  

In his opening remarks during the webinar, Dr. Munson urged AOA members "to report back to us what you're seeing in your state, your region and your community so that we can do everything possible together to consolidate our hard-won legislative and regulatory gains and press for full and fair implementation."  

To keep the AOA informed, email questions and concerns to the TPC.


Click here to listen to the "ACA Implementation-The First 100 Days-Implications for ODs,"  webinar 

April 22, 2014

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