Optometrists’ Integration with Accountable Care Organizations Obvious Key to Health Care Delivery and Cost Containment

By Charles B. Brownlow, OD  PMI, LLC drbrownlow@pmi-eyes.com

As healthcare continues to evolve, providers have been inundated with new policies, regulations, and code sets that they must master in order to be compliant, but also to simply survive. If you are like many ODs, you have spent the last few years focusing on EHR implementation, Meaningful Use (MU), new HIPAA regulations, and, of course, the looming transition to ICD-10. Those issues are all very important to you and your patients, but have you also been paying attention to Accountable Care Organizations (ACO), and how you can be part of them?

An ACO is a group of providers who are jointly held accountable for the care of a group of patients.  The concept is unique, in that the providers are expected to work with the payer in achieving measurable quality improvements and reducing the rate of spending growth. These groups of providers are often part of large health systems and hospital groups, but they can also be a collaboration of a number of smaller providers.

The President of Blue Cross and Blue Shield of North Carolina recently stated: “Even if federal health overhaul is rejected by the Supreme Court or revamped by Congress, the market must continue to change. The [health care delivery/payment] system that brought us to this place is unsustainable. Employers who foot the bill for workers’ health coverage are demanding that Blue Cross identify the providers with the highest quality outcomes and lowest costs.”

Although we might believe that ACOs would not be interested in talking to individual eye doctors, this is not actually the case. In order for an ACO to prove “quality,” one of the items on which they are measured is whether their diabetic patients have a yearly eye exam. This is one of the items factored into their HEDIS score. Very few ACOs have enough eye care providers included on their panels to provide that volume of care. For that reason, they will need to partner with sufficient numbers of individual optometrists to fill in that gap. Failure to integrate optometric services into the ACOs creates an unnatural barrier to patient care, and it hampers the ability of doctors to provide seamless and effective care for their patients.

Using optometrists has also been proven to lower insurers’ costs in urgent eye care situations. The American Optometric Association commissioned a study by SCIO Health Analytics in 2013 to determine the potential benefit of providing appropriate eye care services in different settings (eye care professional’s office, emergency department, and primary care provider’s office). The results of the study indicated that if the cases analyzed had been treated at an optometrist’s office, the cost would have been less than 10% of what was actually spent.

To maximize the savings of eye care services, barriers to optometric care need to be eliminated. Often vision plans are not integrated with health plans.  Instead, they separate “routine” eye care and medical services. This creates an artificial separation between ‘Eye Health’ and ‘Vision’ benefits, and it creates a barrier to patients receiving essential eye care.

The AOA has created a great resource at http://www.rethinkeyecare.com. The amount and quality of information is fantastic. Visit this site to learn more about ACOs, how they work, and to access guides on how to get your practice involved. You can also see a list of all the ACOs in your state at www.aoa.org.  If you are not at least informed regarding the potential changes to the delivery of healthcare through ACOs, your efforts in MU and ICD-10, may be for naught.

Remember…As an association member, you and your staff are able to send questions directly to Dr. Ames at drames@pmi-eyes.com or Dr. Brownlow at drbrownlow@pmi-eyes.com

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