At its annual meeting held in Scottsdale, AZ, this year, the National Association of Vision Care Plans (NAVCP) brought together leading managed care executives to discuss what’s in store for vision care as a result of health care reform.
State Health Insurance Exchanges
One speaker (in a seminar sponsored by Pro Fit Optix), Cheryl S. Smith, director of Leavitt Partners, played a central role in the establishment and administration of one of only two functional exchanges currently operating in the U.S. Created even before the Patient Protection and Affordable Care Act (PPACA) was signed into law, the Utah Health Exchange, with which Smith was involved, may serve as a model for other exchanges mandated to begin operation in each state. She recounted that exchanges were a popular idea even before the PPACA and could serve as a way for states to reform Medicaid.
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| The session sponsored by Pro Fit Optix was introduced by executive vice president Stephen Brewer. |
Robert Holden, VP of Stateside Associates, speaking on state implementation of health care reform, expanded on the discussion regarding state exchanges. Models are already available in two states—Utah, a market organizer, and Massachusetts, considered an active purchaser because the state chooses which carriers participate.
Regarding other states, Holden said that state exchange legislation has already been enacted to date in California, Maryland, North Dakota, Virginia, and West Virginia. Of these, California and Maryland are very similar to the Massachusetts model, and North Dakota and West Virginia are part of the state insurance department and are likely to operate as market organizers like Utah. In Colorado, Hawaii, Vermont, and Washington, legislation has passed the legislature and is now before the Governors. Some 15 other states are still considering bills.
Because not all states have enacted legislation to establish exchanges, Holden predicted that there will need to be a delay on key deadlines in PPACA and that there will need to be increased flexibility and waivers for individual states. He said that there is also the potential for multi-state/regional exchanges, and states are just waiting for a signal in that regard from the federal government.
Will vision care plans be sold on these exchanges? According to Holden, the exchange is a good tool to solve a lot of problems, so other services (such as vision care plans) may be added as well.
Accountable Care Organizations
Taking up only seven pages of the massive new health law, Accountable Care Organizations (ACO) “have become one of the most talked about provisions,” as reported on NPR, which describes them as a network of doctors and hospitals that shares responsibility for providing care
Kyle Stern, co-founder and managing director of HealthScape Advisors made a presentation (sponsored by Essilor of America, Inc.) discussing the nuts and bolts of ACOs, some key industry trends, and what this all means for the vision care industry. He began by stating that after the regulations just came out on March 31st, nobody likes them, not the insurers and not the CEOs of the hospitals. Comments on regulations were open until June 6th. “This is moving forward, and this is moving fast,” he said.
“This is transitioning away from the typical fee-for-service model. Responsible for the entire care of that patient, an ACO lets providers do what they do best, provide care.” However, he added that “members can’t go outside the ACO to secure care.”
Ultimately, Stern predicted that the result of ACOs will be a shifting balance to health and wellness and a greater demand for data collection and reporting. For vision care, he said, “underutilizers might go to the eye doctor more.”
Other speakers included John M. Madigan, managed markets account director for Johnson & Johnson Vision Care (Vistakon Division) speaking about Contact Lens Habits and Practices; Ed Greene, CEO of The Vision Council, along with Marge Axelrad, Sr. VP of Jobson, on Trends in Vision Correction: Is America Seeing Clearly?; and Hugh Parry, president and CEO of Prevent Blindness America, speaking about his organization, its many initiatives related to healthy eyes, and its Swing Fore Sight fundraiser.
Think About Your Eyes
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| Mike Daley, president and executive director of the Foundation for Eye Health Awareness, discussed the success of the Think About Your Eyes campaign. |
Mike Daley, president and executive director of the Foundation for Eye Health Awareness, made a presentation describing the Think About Your Eyes campaign. “For the first time since I’ve been in the industry, we have a message that’s working,” he said. In the nine U.S. cities where the Think About Your Eyes television commercials have been running, there has been a 4% increase in eye exams, a 16% increase in children’s eye exams, and a 36% increase in exams for new patients. In addition, there have been 250,000 unique visitors to the campaign’s Web site and 20,000 consumers interacting with the organization via its social media outlets.
Funded with millions of dollars in seed money from Luxottica, Essilor, and VSP, the Think About Your Eyes campaign has set a goal of going national and is looking for support from the vision community at large in order to obtain sustainable funding. Daley is optimistic because a number of executive boards have written letters supporting the campaign.
NAVCP Moves Forward
Founded in 2002, the National Association of Vision Care Plans established a three-year strategic plan in 2008 with four major goals: 1) to expand awareness of the NAVCP as the voice for the vision benefits industry, 2) enhance the value proposition for membership, 3) expand collaboration and partnership efforts with vision industry organizations, and 4) strengthen the governance and administrative processes to support the goals of the association.
While retaining its core membership, the NAVCP added three new members this year—Pro Fit Optix, VSP, and General Vision Services.
Earlier this year, NAVCP affiliated itself with the National Association of Specialty Health Organizations (NASHO), defined as “a growing group of companies that facilitate, manage, or provide access to specialty care,” which includes vision as well as dental, hearing, behavioral health services, chiropractic, radiology, pharmacy benefit management, and other distinctive services.
The overall subject of the annual NAVCP meeting, health care reform remains a moving target but one that becomes more and more in focus as we move toward its mandated full implementation in 2014. Those on the front lines are doing all they can to react to the new laws while ensuring that their businesses remain profitable while providing vision care for many millions of lives.
John Sailer is senior editor of First Vision Media Group. Contact feedback@visioncareventure.com with comments and/or suggestions for future topics.
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