Healthcare reform and eye care

March 28, 2014

During a presentation at Vision Expo East, Charles Posternack, MD, PACP, FRCPC, chief medical officer of Boca Raton Regional Hospital, said eyecare professionals are poised to have the greatest opportunity of their careers, thanks to healthcare reform and those “willing to accept risk will have the opportunity to capture market share.”

New York City-During a presentation at Vision Expo East, Charles Posternack, MD, PACP, FRCPC, chief medical officer of Boca Raton Regional Hospital, said eyecare professionals are poised to have the greatest opportunity of their careers, thanks to healthcare reform and those “willing to accept risk will have the opportunity to capture market share.”

With about 6 million people currently enrolled in healthcare exchanges, millions more now covered under Medicaid expansions, and Medicare growing daily with an aging population, Dr. Posternack says the most rapid growth in the optical industry will occur in the entitlement programs. Both absolute patient numbers and utilization will increase by virtue of that growth.

However, because healthcare economics cannot keep pace with the rate of utilization, the money funding these programs would be expected to contract, says Dr. Posternack. The cost-effective strategies that are now mainstream in traditional medicine will penetrate into the eyecare world. 

While current plans under the Affordable Care Act require vision coverage only for minors, Dr. Posternack says he doesn’t think it will stay that way for long.

“I can tell you with pretty good confidence that vision coverage is going to be expanded to the entire population within 3 years,” he says.

Dr. Posternack says, when it comes to Medicare:

• High-quality, cost-effective care will drive this benefit

• Robust IT systems will be needed to accomplish transparency

• Vision care will almost certainly evolve into a risk-sharing model, much like mainstream medicine

• ECPs willing to accept risk will have the opportunity to capture market share

• Supply chain of high-quality, low-cost finished eyewear will be crucial for cost containment and quality requirements

With regard to Medicaid:

• Vison benefits, including eye exams and finished eyewear, are a benefit in most plans today

• Most Medicaid today is in a managed network and that number will likely increase to over 90%

• Absolute number of Medicaid participants will soon become 1 in 3 Americans

• Per member per month dollars allocated to vision care benefits are likely to ratchet down over time

• Utilization will likely increase as preventative measures are encouraged and the use of LED devices increases exponentially

• Those willing to accept risk will become market leaders

And for patients with commercial programs:

• New pediatric vision benefits are likely to be highly used

• Employer-sponsored plans will likely look for low-cost, high-quality networks in order to stretch the healthcare dollar