Welcome

Can You Succeed in a Managed Care World?

David Friedfeld, President, and Peter Friedfeld, Executive Vice President, ClearVision Optical

No doubt, your office is inundated with managed care patients. You are not alone—the American Optometric Association's (AOA) 2008 Third-Party/Managed Care Survey found that the "typical" OD patient profile included 50.5 percent of patients covered by private plans and 29.1 percent covered by public health plans (i.e., Medicare, Medicaid, etc.).

This reality certainly doesn't leave much room for self-pay patients today. In fact, the AOA survey found that out-of-pocket payments (including cost-sharing amounts from patients covered by third parties) represented merely 32.2 percent of ECPs' total revenues.

Because managed care is such a predominant part of the patient base today, ECPs who address it properly will certainly be able to grow and thrive. Our goal here at ClearVision is to help you better navigate the sometimes murky waters of third-party business. How can we help you?

1 The Right Product

We offer a wide variety of quality products, including the ClearVision, Koodles, and Junction City collections that are generally priced within the guidelines for private and government managed care plans. With this product, the patient can typically make a purchase without any out-of-pocket cost. For those customers who are willing to trade up—and for those plans that allow customers to reach into their own pockets—we offer frames in sought-after lifestyle and designer brands. This high-quality product encourages upgraded purchases and enables you to make more money on the insurance side.

2 The Best Value

ClearVision delivers a positive price-value relationship along with each and every product to help you better control your managed care product offerings. We work with our customers to determine the exact retail price we can offer on these products to allow you to profit and sell them repeatedly. We know the higher the price we charge the less sell-through and the less turnover you'll see. How are we able to do this? We make a point to run our company with financial efficiency while still providing excellent product. In turn, we can pass this savings along to the customer by providing reasonably priced, high-quality frames all the time.

We have put together this special managed care-focused Beyond the Brand supplement to provide you with new business strategies and solutions for enhancing your profits. We hope you find it useful and we look forward to serving your managed care product needs.

Historical Perspective

With several decades of industry experience under his belt, ClearVision founder Fred Friedfeld shares his thoughts on the history of managed care. Q: When did managed care become an important part of the eyecare business? Managed care as we know it started in the 1940s and 1950s with California Vision Service Plan. In 1965, U.S. Congress instituted Medicare/Medicaid for older and low-income adults. Q: How did it grow over the years? In the 1970s, managed care started coming into its own. In order to compete for the best employees, many employers added vision plans. In the 1980s and 1990s when the economy was strong, we started to see vision and dental care riders being written onto major medical plans. Q: How did frame manufacturers meet ECPs' needs with managed care-friendly products? In the 1970s and 1980s, the government and many unions required specific price points or "Made in America" products for Medicaid/Medicare patients. In the 1980s and 1990s managed care changed and, depending on the plan, patients could either choose from a selection of "free" frames or upgrade and pay more for a designer brand. Thus, the concept of up-selling began. Q: Has managed care been a positive force for the eyecare industry? It's a double-edged sword. In many instances, if a practice has adapted its processes, procedures, and materials to a managed care environment, it has been very positive. But if ECPs don't change as effectively, it can become a little more difficult for them to provide the care they want to because a third party is involved in the process.

The Customer In Focus

How do ECPs survive (and even thrive) in a managed care world?

Robert Ratzlaff, OD, Real Eyes

This optometric practice in Taos, NM, boasts a patient base of at least 70 percent managed care patients including Medicare/Medicaid and big insurance plans. "This number has grown over the last few years—we're taking more Medicare patients today," says Robert Ratzlaff, OD.

Q: How do you make money in a managed care environment? We have taken it upon ourselves to drop a few minor insurances—and at least one vision plan—that lack a solid number of patients. We only take some of the bigger, more marketable plans.
You have to look at your bottom line and most practice management software points out the lowest reimbursements you're getting and the specific plans that are not performing.
We also train our staff to really focus on what the patients' needs are to help them see the value in better products so they can make a good, conscious, intelligent buy. This is the only way to make a profit with managed care.

Q: How do you meet your product needs? ClearVision has a range of really good products that are durable and functional—they fit into whatever the plan value may be. We also like that their exchange and warranty policies are above and beyond what other vendors offer.

John McPherson, optician, Vestal Eye Care

This single-office optometric location in Vestal, NY, caters to a clientele that is 70 to 75 percent managed care patients. "This number has not grown and the majority of the patients we see are returning because their eyecare benefits have not changed and most are entitled to an exam or eyewear every year," says optician John McPherson.

Q: How do you make money in a managed care environment? We believe it's a mistake to sit down at the table and say 'This is what your plan covers. What were you looking for today?' Instead, we sell them a pair of glasses first and tell them how much their eyecare benefit saved them. We don't prejudge patients based on their eyecare plan; they deserve to see the entire selection of frame and lens options available. We also believe you have to set a profile and guidelines when considering whether or not to accept plans. Some offices take every plan that's available."

Q: How do you meet your product needs? We like working with ClearVision because they've got something for everyone. The other advantage is ClearVision only has one sales rep for you to see. Today, you have one company and they have five reps. Time is so hard to come by and five reps is a good three to five hours. With ClearVision you just see one.

Sandy Lesnick, owner, Lesnick Optical

This multi-location optical chain also includes Belleville Vision Center and VisionPro Eyecare in the Detroit metro area. Here, about 70 percent of patients have managed care plans, including Medicare and Medicaid. "We don't make as much money per patient but we are seeing more people because we are working harder," says optician/owner Sandy Lesnick.

Q: How do you make money in a managed care environment? We tell our patients about all the options available, we don't just stay with the basics. Then they decide if they want to pay the difference and upgrade to things like PAL lenses and AR or scratch-resistant coatings. We find that about 70 percent are willing to pay a difference. We also know which plans are more profitable and try to focus on those. Some plans pay so little it just doesn't pay to accept them.

Q: How do you meet your product needs? We find that many people want more than what their frame coverage is, especially when they see what we have available and the way it's displayed. ClearVision is a very good product for us and much is priced just right in the middle of everything. It's just the range we like to work in and managed care customers feel comfortable with that price range.