Evaluating and Signing Up for Managed Care Plans, Part 1
June 1, 2016
Managed health care, including new plans under the Affordable Care Act (ACA), traditional medical insurance and even vision care plans, requires practice owners to educate themselves and make important decisions. Put this topic on your growing list of things to do as CEO of your practice. In this article, I’ll give you some guidance on how to evaluate and participate in the plans that are good for your practice.
It is tempting for some ODs to try to outsource some of the tougher aspects of running a practice. Maybe you can hire a firm to take care of it for you or maybe you can delegate it to a staff member. But in most cases, other people are not going to be able to make important decisions about your practice for you. You might be able to outsource some peripheral functions of your practice, but not the core management. You might be able to delegate routine tasks to your staff, but not strategic decision-making.
More often, ODs just don’t work on it
When some aspects of running the business are too time-consuming or too demanding, most ODs simply don’t do it. In the case of our topic of evaluating managed care, many ODs go for years without looking into a new insurance plan. They may eventually be prompted to consider a plan if they receive an invitation to join from the insurance company or if several patients ask if the practice accepts a plan. That method will work, but I recommend you take a much more proactive approach. No one can do it for you.
There are many other business aspects that don’t get enough time from the OD/CEO, like human resource management, marketing the practice, regulatory and insurance compliance, office technology updates and many more tasks. When is an OD supposed to find the time to do all this and see patients too?
The answer is simply not to avoid these business tasks. The answer is to improve time management and work smarter, not harder. It is really not difficult to do these tasks if you just had the time. It is actually gratifying once you jump in because you know your practice is getting the attention it needs. Time management is a topic for a future article, but for many ODs, a big step in the right direction is to make eye exams more efficient. Compress the same number of exams into fewer days per week and delegate more data collection to staff. Make the eye exam a shorter event in most cases.
Make some time in your schedule to research and work on managed care.
What plans are out there?
Do some basic research about the medical insurance and vision plans that are present in your area. Assign some of these tasks to your staff and you should appoint someone to be the insurance coordinator if you don’t currently have an employee with that title. Keep written records of your phone calls and Google searches.
Start by making a detailed list of all the plans you already accept in your practice. Separate the vision plans from medical.
Make a second list of managed care plans that exist in your area and keep notes under each one, such as how popular the plan is, what local employers offer it, and physicians and ODs who accept the plan. At first, you may not know some of this, but you’ll learn.
Ask your staff about the names of insurance plans that patients ask about when they call your office.
Look up the websites of local optometrists and ophthalmologists and read which insurance plans are listed as those they accept.
Research your state Medicaid plan. You may have looked into Medicaid in the past, but it has changed drastically in many states and you need to look again. Many new Obamacare plans are administered through the Medicaid program. There are often several different plans under Medicaid and some pay very well and are administered by third party plans you already work with. Some Medicaid plans are no longer just for the unemployed, but for people who have jobs that do not provide benefits.
Do a Google search for Medicaid in your state and other medical plans. These sites are not always very user friendly, but spend time reading them anyway.
Medicare is generally a must-have plan for your practice, but write down the names of popular Medicare Advantage plans that your patients bring in. Call the provider support line and ask about how to become a provider.
Talk to local colleagues, ODs and MDs, about the managed care plans they accept and ask for their advice. More on this in the next issue.
I’ll continue this topic next week, and we’ll cover questions such as: Do you really want to join a plan? Will you be locked out of a plan? If you join a plan, will you see any referrals or patients? How do you submit an application and get credentialed?
Begin to think about how to become more informed about managed care. Read information about insurance plans and health care reform from the AOA and your state association. If you are not a member, this is reason enough to join. Read more in professional journals and newsletters. Read the news and current events sections of these publications, in addition to management articles.