Rethinking eye health and vision care

August 17, 2015
AOA initiative informs about necessity of integrated benefits.

Significant changes in health care have created a new market reality for doctors of optometry, one in which better patients outcomes, lower costs and expanded (or broader) practice scope walk hand-in-hand.

"The AOA advocates for inclusion and fairness for optometrists, and works to expand protections."

In keeping with this sweeping health care reform that stresses quality and cost savings, the AOA Third Party Center (TPC) initiative, rethink eyecare , continues to educate payers, purchasers and patients nationwide on the benefits of including and integrating eye health and vision care as a core component of health benefit packages.

"What are we rethinking?" asks Stephen Montaquila, O.D., AOA TPC Executive Committee chair. "The impact that eye health has on vision is remarkable, but we've accepted over the years that payers have separated vision care services from total eye health and overall patient care—that there are different sources of payment when providing eye health and vision care services." It's time to rethink why that happened and how we can fix it."

Trends in health care

Knowing that doctors of optometry are a significant access point for eye care services positions doctors well for growth in this new system, Dr. Montaquila says.

As highlighted by the TPC's "Optometry in the Changing Healthcare Delivery System" webinar, the Affordable Care Act (ACA) presents both opportunities—as cited by inclusion of the pediatric optometric essential health benefit—and challenges, such as variability among states' interpretation of this benefit or elimination of adult routine vision benefits to cover the pediatric benefit.

So, too, are new trends appearing among states in recent years, including:

  • Vertical integration of vision plans.
  • Vision plan companies requiring participation in all plans.
  • New credentialing requirements to participate in a medical plan.
  • Network requirements only applying to doctors of optometry.
  • Skinny networks.
  • Changes in health care regulations that create disparity in optometry laws and cause confusion.

Read more about how Kentucku successfully pushed legislation that eliminated forced vision plan participation to access a medical plan.

Integrating and embedding

Vision plan strengths are in delivering discounted materials benefits—such as eyeglasses and contact lenses—but when these plans aren't integrated with health plans, it can create a barrier to patients receiving essential care.

Dr. Montaquila uses the example of a patient diagnosed with dry eye syndrome. Her vision plan only covers nonmedical care, and while normally her medical plan would pay, the doctor isn't on the panel. In this circumstance, the patient pays out of pocket because she had no way of knowing if her blurry,  tired eyes were a medical condition and thus had no way to make a decision on what provider to choose from when making the appointment.

That's why the AOA TPC advocate for practical solutions that ultimately lead to better patient outcomes and lower health care costs, through legislation and engagement with emerging value-based care models, such as accountable care organizations (ACOs) and integrated provider networks.

As insurers react to the ACA through cost-saving business decisions, the AOA and state affiliates work to ensure payers are following the laws and regulations designed to protect doctors of optometry and their patients. This is bolstered through access/nondiscrimination laws, such as:

  • General nondiscrimination.
  • Freedom of choice.
  • Direct access.
  • Payment parity.
  • Any willing provider.

"The AOA advocates for inclusion and fairness for optometrists, and works to expand protections under the law and regulations," Dr. Montaquila says. "We want all doctors of optometry to practice to the fullest extent of their licensure and to be reimbursed the same as other health care providers who provide the same services."

To learn more about current trends in health care and how to best take advantage of expanded scope of practice and payment offered by past and recent changes in law.

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