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Managed Vision Care can mean that a patient gets more
value than they initially could afford. That would allow them better and more
individualized eyewear or contact lenses. It also has the opportunity to
improve the overall eye health and general health status of all its members.
Use it as a benefit that means more than just the dollars a patient sees as
their benefit for eyewear and eyecare.
From its inception, the idea of managed vision care in
the optical industry was met with suspicion, skepticism and for some, downright
anger. Many perceived that the insurance companies had an implied directive,
make it impersonal and forget about how you used to do business, give up your
control, sign on or perish. Naturally if that were true no professional
provider would embrace third party plans as a positive. At the dawn of a
managed vision care world eyecare professionals were forced into a strange and
frightening atmosphere of negative perceptions: Free Glasses for the Patient,
Loss of Dollars to the Practice, Increased Administration, Confusion,
Frustration and Loss of Control.
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PUT THE BENEFITS BACK INTO MANAGED CARE
As stated in the old adage, our perceptions became
our new reality. Unfortunately many of those early adversarial beliefs still
linger in our minds today. The truth is when managed vision care is approached
from a position of fear and misunderstanding all of the negatives easily comes
true. We immediately saw managed vision care as a threat so we played along
like the guy that says, nice doggie, nice doggie all the while looking for a
big rock to shoo the menace away. With managed vision care viewed as a threat,
it took years of cold warfare to finally reach a point where detente became the
desired position from both sides. The inevitable fact is that managed vision
care is here to stay so, it is now time to evaluate, in a more positive way, a
realistic approach to making managed vision care benefit patient and
practitioner.
For the patient it means a regular, preventive
examination that leads to better eye health, potentially identifying general
health risks, more timely treatment of serious eye conditions and the
confidence their eyes are best cared for. In addition, in eyewear they can
purchase a better selection of brands and wear the materials, designs and
treatments that make eyewear exceptional.
For the practitioner, managed vision care can increase
the patient base; contribute to the stability and growth of the practice while
it increases the eyewear options patients benefit from most. It also requires a
knowledgeable staff to best utilize all of its opportunities. It is also likely
that managed vision care is partly responsible for the reduction in the eyewear
repurchase cycle. With consistent recall and pre-appointing as part of a
patients ongoing exam benefit, patients are buying eyewear more frequently.
Today, the repurchase cycle is 1.9 to 2.1 years, according to a study by
VisionWatch/VCA); older patients buy more frequently. It was not too long ago
that patients bought every 2.8 to 3 years. Managed vision care helps.
MAKE MANAGED CARE BENEFICIAL
How can we help the patient understand the
opportunities of managed vision care? Simple, its a list of Did you know
For example:
Did you know that you can have a yearly preventive
eye examination that can detect not only eye conditions but also can identify
your risk fordiabetes, hypertension, high cholesterol and
many others.
Did you know with your plan, you could get that Prada
frame at little more than the cost of an ordinary non-branded frame.
Did you know you could upgrade to the better and best
in each lens category for a small extra cost. That means we can make you a pair
of glasses where the lenses are between 25 and 50 percent thinner and lighter.
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Create a form showing patients how they
can save with their managed vision care benefit for better eye health and
exactly the eye-wear they want.
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Did you know the newest progressive design will make
you more comfortable reading and is part of the plan that covers part of your
eyewear costs. In fact, even the newest personalized progressives that adjust
to you rather than you adjusting to them are also covered.
I can see that a partial payment for the best
anti-glare lenses is provided, did you know that means the clearest and easiest
to care for anti-reflective lenses and/or the most comfortable and safest
polarized sunglasses are available through your plan.
Did you know since the fist pair is covered in part,
you can apply the savings as a head start to a pair of prescription sunglasses
(readers, computer specs) that will make vision everyday more comfortable and
enjoyable.
Begin by describing the benefit of eyewear opportunities
and then the benefit of the plan and how the plan makes eyewear more fun.
MAKE MANAGED CARE PROFITABLE
In order to make managed care profitable turn
traditional thinking inside out. The plan does not define the limits of the
patients coverage, but rather it raises the bar by covering basic costs.
It frees the patients budget for premium upgrades. The purpose of the plan is
not to get everyone into a basic set of glasses that cant fit their specific
needs but rather to cover commodity costs allowing the patient the opportunity
to pay for items that add specific value.
The best answer to the question What does my plan
cover? is Your plan covers everything. It will cover very basic choices
completely or it will cover in part more premium items that are specific to
your needs. Your plan enables you to get the very best eyewear at a
much-reduced cost. A good approach to using insurance would be to present to
the actual level of the patients needs, at the total standard price and then
let them see how their insurance will save them money. For example, Your total
charges are $375, but with your insurance coverage, your responsibility is only
$185, a savings of $190.
HAVE A PLAN FOR MANAGING YOUR PLANS
If a practice is not discerning about which plans it accepts for
assignment, it will soon be bogged down in a confusing jumble, many of which
tax professional time. An evaluation of the plans currently covered would be
appropriate. With a better idea of your chair cost you may find some plans
should be dropped. Here are some guidelines for evaluating plans. Talk to plan
reps for answers and discuss them with colleagues at professional meetings.
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Like frame and lens
products, you should limit the number of plans in which you participate and
strongly advocate those that work best.
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Reputation and track
recordHow long have they been around, how many members, performance?
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Does the plan cause you to
change the way you operate in normal, everyday practice?
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Does a card guarantee
coverage or can coverage be denied after the service?
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What is the frequency of
reimbursement, payment within 30 days, refusal after 90 days?
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Do they use electronic,
Internet or phone authorizations?
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Are their fee schedules
realistic for your practice?
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What is the number of
members you will realistically attract if you participate?
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In which plans do your
immediate competitors participate?
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For the very large
businesses near your office, which plan is provided to employees?
Once the key plans are separated from the lesser ones
outline an office strategy to be used by everyone when dealing with the plan
and the products covered by the plan.
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Post the plans accepted for assignment at the front
desk. This eliminates confusion at the end of the process.
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Since office policy dictates which plans are accepted
for assignment there should be no misunderstandings. If a plan is not listed
explain that you will assist them with the information they need to file their
own claim.
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Over the phone and at the time of scheduling, request
the type of insurance, employer name, insured name and policy number This will
save time and frustration at the front desk on the day of the service. It is
also recommended you obtain information concerning their medical coverage as
the professional may discover a condition that is more appropriately billed to
the medical plan and the patient accepts this.
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On the day of the scheduled appointment, for plans
you accept, get authorization in advance of the patients arrivalif there is a
denial, call the patient immediately in order to allow them to cancel or
re-schedule at a later date when coverage is back in force.
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Educate the entire staff as to the plans that are
accepted and the particulars of each plan. Patients are
often misinformed as to their coverage so a staff that is knowledgeable will be
of great help in assuring understanding and efficiency. While many offices have
one insurance expertit helps if all staff learns the basics of the plans
accepted. In fact, this is a good goal for the review process.
MANAGE YOUR BUSINESS BEFORE YOU MANAGE A PLAN
To assure the best new beginning of a
managed vision care approach, it is important to lay a solid foundation. Goals,
budget and the P&L should be determined. Then, the effects of managed
vision care i.e., the adjustments to the gross revenue of the business, can be
calculated. It is necessary for the professional to evaluate a variety of
critical practice benchmarks.
For example, when the business includes exams, list and
record appointments possible vs. appointments filled as well as appointments
canceled. The visibility of these ratios allows planning to improve reception
and appointment efficiency. Next, how many exams are converted to eyewear? Its
a measure of productivity, effective sales and dispensing.
Next, the business manager and owner can look at gross
sales, the exam and eyewear sales dollars written down for participation in the
plans and the percent of managed vision care in dollars and patients.
Contrast this to the number of new patients and the
plans in which they participate. The percent increase in traffic must grow year
on year since every practice loses patients. Understand which plans are driving
patients and the plans in which you participate that should be advertised, if
permitted.
Record the multiple pair sales i.e., all eyewear sales
vs. patients that purchased. This ratio is an indication of the increased
number of private paid jobs that offsets what might be an overly high
participation in too many plans. Develop a spreadsheet example using these
topics and the results. It allows an office to identify and focus on problems,
then develop a plan to improve each of the variables
Heres an example using capture rate. It is simply the
percentage of eye-wear prescriptions written in a practice that are filled in
its own dispensary. Capture rate provides a valuable measure of the quality of
the practices ability to meet patient needs.
For example if two practices both dispense 150 pairs of
glasses a month, one might assume they are both doing equally well. However, if
the first practice wrote 300 prescriptions (50 percent capture), the second
practice wrote 200 prescriptions (75 percent capture) the second practice is
clearly doing a better job attracting patients to its dispensary and selling
them product. The first practice needs to evaluate why half of its patients
chose to obtain their eyewear elsewhere.
With managed vision care dominating the majority of
traffic, this may be a very early indicator the practice is not properly using
managed vision care as a profit-building tool. If the first practice were to
increase its capture rate by only 5 percent, it could add $3,750 per month or
an annual $45,000 to its gross sales (assuming that an average pair of glasses
retails at $250).
Chair cost is also an indicator of profitability. It
doesnt make good sense to involve yourself with any plan that does not, on a
per patient basis pay for your cost of doing business plus some profit. In
order to arrive at this number you could take your gross income less cost of
goods and doctors income. What is left will be fixed costs (chair cost). If the
fixed costs were $250,000 and you saw 2,100 patients your chair cost would be
around $119 per patient. Even if existing patients are meeting fixed costs, no
plan that pays less than that is worth getting involved in.
Why increase the workflow only to remain about where you
were without the plan? If on the other hand your staff is capable of selling
comfortably beyond the plans allowables the increased flow may be very
profitable. It is not an exact science, but let it suffice to say that a plan
that just meets chair cost along with a doctor/staff team that struggles with
upward premium selling will drag the practice in a downward direction.
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When Selecting Managed
Care Plans, Consider
Choice
Choice of production laboratory
Little or no product restrictions
Product brand choices
Ability to accept or decline
non-standard
plans
Easy Administration
Web connectivity for easy
administration
Patient ID cards
Dedicated 800 number
Competitive
Reimbursements
Profitability
Extent of the reimbursement
schedule
Strong Communication
& Support
Effective and frequent
communication
Dedicated professional support
manager
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BE PROACTIVE WITH MANAGED CARE
With a positive approach to using managed vision
care you have the opportunity to become the source that places you in a strong
directing position. You manage the personal care of patients. True personal
care emanates from the close relationship developed between you, the patient
and your staff. Personal care demands satisfying an individuals needs. Managed
vision care plans are not opposed to that goal and when applied in a positive
way, managed vision care becomes a tool and strong ally in achieving excellent
patient care.
Perhaps it was due to the novelty of the idea insurance
would now pay for something that up to now was always an out-of-pocket expense,
but regardless, managed vision care went down the wrong track for many offices.
To a great degree eyecare professionals were told what they could sell/dispense
and how much they could charge. An adversarial atmosphere was immediately
established between the plans and their providers. This initial friction did a
great deal to impede managed vision care from evolving into the positive force
that it was ideally meant to be. A new beginning requires a rethinking of how
to best harness the power of the plan.
The first step in moving ahead should be re-defining
how managed vision care should work. In its initial and most negative mode,
managed vision care meant the parameters of the plan defined the beginning and
the end of what a patient could get. The primary flaw in this approach was the
assumption the patient only wanted what the plan would cover with minimal
out of pocket expense. Of course this approach was disastrous to the formative
years of managed vision care. Dispensers actually began by either responding to
the patients question of What does my plan cover? or worse by initiating the
dispensing process by explaining the basic limits the plan would cover for
free. With that, it was over.
Beginning with the lowest quote (even though it was for
the most basic of products) made the attempt to move patients into more
appropriate eyewear for their actual needs seem like high-pressure selling and
piling on. In short, this approach minimized premium sales and often defined
patient care as the lowest common denominator of their plans coverage.
THE KEY TO PROFITABILITY COMES FROM SELLING BEYOND THE
BASICS
By far the most important part of a successful managed care plan is the
follow up that allows the practice to sell through the plan. A profitable
managed care practice rests on the ability of the doctor and staff to use the
plan as a basic foundation from which the goal of providing the highest-quality
eyewear to everyone may be accomplished. Using any plan at its most basic level
may assure subsistence by covering chair costs and modest profit, but no one
really benefits until the patient, the plan and the practitioner all come
together to allow for a partnership of high-quality performance eyewear.
A profitable managed vision care practice uses the plan
coverage to lay the foundation while letting the patient know that for a
minimal out-of-pocket expense they can get the very best the industry has to
offer. It is the extra items that better benefit both patient and practice.
Approach the patient from the perspective that an ideal
pair of glasses would use technically advanced materials and advanced design
for enhanced optics.
For example, a quality frame would provide style, be
lightweight and durable, polycarbonate lens material creates 25 percent
thinner, lighter lenses that are super impact resistant, 100 percent
ultraviolet absorbing and scratch resistant. New digitally surfaced progressive
lenses provide better vision at all distances than previous lenses and come
with special anti-reflective surfaces for enhanced optics, great cosmetics,
easy cleaning and scratch resistance.
If
you didnt have your vision plan, these glasses would be
| Frame |
$150.00 |
| Polycarbonate |
50.00 |
| Progressive |
230.00 |
| AR lenses |
95.00 |
| Total
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$525.00
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The next part of the process becomes the good
news. But in your case since you have
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Plan A
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Plan B
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Plan C
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Frame
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$24
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$16
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$34
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Polycarbonate
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$32
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$40
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$35
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Progressive
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$87
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$88
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$161
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AR
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$51
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$45
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$67
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Co-Pay
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$10
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$60
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$0
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Total
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$204
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$276
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$229
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You save
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$321
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$276
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$229
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(For
purpose of comparison Varilux Comfort with Crizal AR were used on all.)
In all of the above cases using a standard multi-focal
with non-AR, plastic lenses would have been the totally covered minimum, and
while that may have covered chair costs it would not add up to a profitable
exchange for either the patient related to needs or wants or the practice.
SWITCH THE ROLE OF INSURANCE FROM VILLAIN TO HERO
Managed vision care is an on ramp for
patients to get the best. Their plan and the coverage provide a positive
healthcare benefit. Before the patient asks whats covered, position managed
vision care as a springboard, a premium value filled package. Their coverage is
the down payment that covers the basics, so the patient can afford to spend a
little extra out-of-pocket to get the very best.
Take the initiative and avoid reinforcing the notion if
thats what my plan covers, that must be all I need. Dont make the plan the
villain by saying, Your plan only covers. or Let me show you what you are
allowed to get Make managed vision care the hero. Instead consider saying,
Lets talk about what you want and need, and Ill make sure you get the best
possible benefit from your plan or Your plan really helps in keeping your
costs down, let me show you how much you are saving or With your plan, we
can get you the very best at a fraction of the cost.
CONCLUSION
Managed vision care is a reality that is
here to stay. It means that patients can get more than they initially thought
and allows them better and more individualized eyewear. It improves their eye
health, can detect general health risks and can better improve their vision
through eyeglasses or contact lenses. Use it as a benefit that means more than
just the dollars a patient sees as their benefit for eyewear and eyecare.
Managed care can be a powerful force in providing real benefits to patients
while building a profitable future.
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