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Connect the Docs: Make the Connections Required By Healthcare Reform

By Aaron Lech, OD, FAAO

Is your practice preparing for healthcare reform? Now is the time to learn about the healthcare exchanges and other healthcare providers your practice can connect with to provide total care to patients. Optometric alliances can help you network with other doctors and provide you with the education you need to thrive in this new environment.

Healthcare reform is here, and along with it, changes that need to be implemented in your practice. The days of doctors operating in silos with little-to-no integrated care and no association with regional players or other networks will soon be a thing of the past. To prepare for these changes in our healthcare system, it’s time to learn about the healthcare exchanges and marketplaces your practice will need to link up to. It’s also time to think about how equipped your office is for integrated care and collaboration with other doctors and institutions. The educational resources provided by alliances such as one I work with, Primary Eyecare Network (PEN), can help you better understand how to ready your practice for the changes I outline below.

Fee for Service Model Will be Replaced
In many cases, payment will be based on total care rather than individual services or office visits. Rather than charging patients and their third-party providers for individual services like treating an eye infection, an eyecare emergency or for each visit to monitor a chronic condition like glaucoma, doctors will receive payment for the total care the patient received. That means that payment will be based on whether or not the patient received the care they needed to control a condition or maintain their health, emphasizing both timeliness and quality of care.

For instance, if you saw the glaucoma patient five times over the course of a year, the heatlhcare exchange that a patient receives insurance from might not be required to fully reimburse you for your services if determines that the patient did not receive the quality of care she needed from you and the other doctors the contract is associated with. If you did everything right, but one of the patient’s other doctors, whom under heatlhcare reform you will be responsible for working with, did not sufficiently monitor her blood pressure or diabetes making it difficult to control the glaucoma, you, along with all the other doctors who cared for her, may not be paid in full.

Connect with Other Healthcare Providers to Create Interdisciplinary Teams
With risk shared across all the doctors who provide care to a patient, it is essential that you begin now to forge relationships with other doctors, including other specialists, if you have not done so already. That means connecting with internists, pediatricians and endocrinologists, among others. Even though healthcare reform will not be fully implemented until next year, you should start now to think about how you will expand your co-management abilities as relationships with other practices can take a long time to forge.

To connect with other healthcare providers, it may be useful to employ guerilla tactics when establishing relationships. Don’t fixate on meeting with or speaking to the head of the practice. Often through the practice’s nurse practitioners and physicians’ assistants, and other support staff, you will find receptive individuals to your overtures. In many cases they have greater influence over referral patterns and integrated care.

Network with Other Optometric Practices for Greater Leverage
Alliances with other optometric practices will become more important as consumers are able to shop around to find which exchange(s) provide them the plans with the best value to cover their healthcare expenses. Optometric practices can market themselves together to healthcare exchanges or health plans as integrated eye health providers in a geographic area or region. An office may work with these other practices to agree on quality guidelines that create additional value to these payers, securing great access to patients.

A group like PEN can help you identify other like-minded optometric practices. You can use alliances like PEN to aggregate a group of ODs with the same outlook who can discuss the value of integration in your region.

Prepare Staff to Provide Integrative Care
As you network with MDs and other optometrists to provide care to patients, your staff will have to be aware of the transition away from fee-for-service, and the importance of ensuring patients receive the care they need from all of the doctors responsible for treating them. That means having a greater understanding of the medical world beyond optometry.

Having staff trained in integrative medical procedures such as checking blood pressure or assessing body mass index, along with the terminology around diabetes care like blood glucose, will be a must. In more medically forward states, staff may need to know how to perform a blood glucose, A1C, cholesterol or other such screening tests.In as little as five years there may be apps available for download to smartphones or tablets that will enable your staff to easily conduct basic medical testing in your office. For example, a test developed by MIT allows medical staff to screen for anemia with a pulse of light from a smartphone.

As healthcare reform requires doctors to provide care that focuses on whether the patient has been sufficiently cared for–rather than paying for individual services–taking advantage of all tools available to care for patients will become more important.

Resources

Health Insurance Marketplace for Individuals

FAQs on Health Insurance Exchanges

Related ROB Articles

Optometric Alliances: Your OD-to-OD Educational Resource
Vendor Partnerships: Strengthen to Gain a Competitive Edge
Insurance Credentialing: Path to Practice Growth

Aaron Lech, OD, FAAO, is a partner of ClearVue Eye Care in Roseville, Calif. To contact him: drlech@clearvue.org

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