Article

Managed Vision Care: How To Pick Plans

Minimize frustrations and generate a win for patients and your practice

Unless you operate a specialty practice, or practice in an area where there are few competing eye care providers (ECPs), adopting best practices for attracting new and, more importantly, loyal patients is essential to the success of your practice. Picking managed vision care (MVC) plans to participate in is part of that best practice, particularly if your practice is new. (For The Vision Council data on patient usage, see tables in the following pages.)

1 IDENTIFY EMPLOYERS IN YOUR AREA

Find out the major employers within your practice’s demographic area, and see how many local people they employ to get a rough idea of the number of potential patients. Your chamber of commerce is a valuable resource for this data and can assist you in building these relationships, networking, marketing programs and events and promoting the visibility of your practice within the community. Also, the chambers of commerce are extremely helpful in connecting your practice with other businesses in the area, which can enable you to increase your visibility and, thus, patients.

2 DETERMINE EMPLOYER PLANS/SUBSCRIBERS

Now, in knowing the major employers in your practice area, contact the heads of the human resource departments of each employer to determine what managed vision care plans they offer and how many of their local employees are enrolled in their vision benefits. Employers understand that having the right balance of benefits is a key to employee retention — workforce turnover is costly — and to lowering their overall unexpected expenses. Thus, it is in their best interest to establish a rapport with ECPs who can provide services to their employees. Also, employers can assist with marketing your practice internally, should you decide to become a provider in their plans. This is a huge benefit to your practice because direct marketing to potential patients is time consuming and can be quite expensive. Further, gaining multiple patients at once through employers is much more cost effective than gaining one at a time.

3 INVESTIGATE COMPETING PROVIDERS

Next, identify the ECPs you compete with who are plan providers of the employer-provided managed vision care plans you’ve uncovered. Doing so allows you to make an informed decision of whether it’s worth it to participate in the, often, lengthy credentialing process of becoming a provider.

For example, if 20 other optometrists in your area provide for a particular managed vision care plan, members of that plan have plenty of choices of where to use their benefits, so it may not be worth your efforts to become a provider of that plan. That said, keep in mind that patients can be fickle. So, if your practice provides exceptional customer service, you have an excellent chance of getting the lion’s share of a plan that several competitors offer.

Courtesy of The Vision Council 2017 Usage & Behavior Study, which included a balanced and weighted 10,507 respondents representing those with or without managed vision care plans.

If you are a new practitioner, becoming a provider on as many plans as possible is a great strategic part of your practice becoming “established.”

4 SCRUTINIZE FEATURES

Should you decide one or more of the managed vision care plans offered by local employers makes sense for you from a competitive standpoint, it’s time to scrutinize the features of the plans. Specifically, determine:

  • Plan value. Remember, plans vary in degree, in terms of eligibility for comprehensive examinations, contact lens benefits and discounts on materials in your optical, including frames, lens materials and coatings. So, if your practice is mostly medical, you may want to consider the examination reimbursement.
  • Contract. Because managed care contracts are a significant portion of a practice’s revenue, it is important to understand your risk and the need to minimize denial of claims, so you can budget appropriately. Some medically necessary services and materials under a plan may have specific criteria to be met to initiate the claims process. These processes are usually outlined in the plan contract. Are you satisfied with the outlined review process, and would you be comfortable explaining the review process to patients? (See, “Contract Negotiation Tips,” p.23.)
    Also, review the terms, especially articles that define automatic renewals and expiration dates. Look for terms that outline your ability for reimbursement adjustments, specifically in multi-year contracts. Are modifications allowed annually, or once per contract? How much notice do you have to submit to end a contract without penalties or to request adjustments?
  • Local specialists that accept the plan. Check which specialists, such as rheumatologists, in your area accept the associated medical plan if you have to make a referral. It is just as frustrating for your patients when you refer them to a specializing physician who does not accept their insurance.
  • Audit frequency. If you’re already on plans or just getting started, know what, where and how you’re going to be audited. Make sure you know what the standards are and when and how they can be changed, so you know when an audit is coming.
  • Appeal process. Understand what you’re signing up for. Will you have to go before a panel? Arbitration? Be aware of what it is, so if something happens, you would know the next steps you’d have to take.

Contract Negotiation Tips

IN GENERAL, NEGOTIATING WITH PAYERS IS NOT DIFFICULT, BUT IT DOES REQUIRE YOU TO DO YOUR HOMEWORK:

  • Conduct a SWOT analysis. (See https://bit.ly/2PwqgAu ) Demographic markets are saturated with other providers, which may not give you leverage in a negotiation. Conducting a SWOT analysis about your internal data, however, may prove to give you that leverage. SWOT stands for strengths, weaknesses, opportunities and threats and is typically performed during any strategic planning process. It gives you the ability to identify and understand key issues, that you could use to your advantage during the negotiation process. While there are always opportunities for improvement with any practice or business, demonstrating an understanding of your business by addressing any weaknesses, taking advantage of your strengths, capitalizing on opportunities and deterring threats during a negotiation can assure satisfaction of a plan’s members. In addition, presenting utilization and quality measures data, along with a list of services that are most frequently administered, can prove effective as well.
  • Amass market share and demographic data. Sharing patient satisfaction and positive feedback, like net promoter score and social media reviews, is not just boasting how great your practice is, it demonstrates to a managed vision care plan that their members will be happy with the care and services they receive from your practice. Managed care plans bid and compete for employer contracts constantly, and they understand the ramifications of losing those contracts due to employee/member dissatisfaction. Plans may be willing to negotiate with you, knowing they will have leverage to negotiate contracts with employers.
    Overall, managed care plans are complicated, and their contracts can be confusing. It does not help that consolidation amongst the payer landscape can diminish your leverage regarding negotiations to become a provider. If you’re not comfortable with contracts, remember contract attorneys are available to retain for these matters.

A FINAL THOUGHT

In establishing best practices to maintain and attract new patients, optometrists should accept the responsibility of educating patients on their plans. This includes covered services, their allowances regarding materials and whether materials are in-network or out-of-network. Most of the time, patients receive their vision benefits from their employer, along with dental, medical and retirement information, which can be overwhelming. By taking the time to explain their plan, you are providing an extra level of customer service — highly valued by patients — while decreasing the likelihood of plan “headaches” for them and your practice. All parties win. OM