By Jennifer Williams, OD
Dec. 21, 2022
Managed care can be a barrier to profitability for many practices, and can adversely impact the patient experience with the required sale of specified products and the mandated use of designated optical labs.
Luckily, a technology solution, Anagram Access, is available that has freed practices like mine from these limitations. It allows us to quickly and easily submit requests for reimbursement to our patients’ insurance providers, even when we are out-of-network with those providers.
Widening Practice Growth Opportunities
We started an independent optometry office in January 2020 after a private equity group acquired our previous location. As we opened our new office, we were denied access to be providers for certain managed care plans at the new location. This presented an obstacle for many of our long-time patients who wanted to continue their eyecare with our doctors at our new office, but still wanted to use their vision benefits. At first, we thought we would lose patients by not being providers for these vision plans, but the opposite turned out to be true.
We implemented Anagram Access in July 2022, and this presented a great opportunity for both our new office and our long-time patients with certain managed care vision plans. Patients were excited to be able to use their benefits at our office with our doctors, especially once they saw how simple the process was to visit an open-access office. We implemented Anagram Access in an effort to retain long-time managed care patients while growing our new practice.
We still accept a few managed vision care plans. Because we are a fairly new office, we were able to be selective on which plans we started with. We do not foresee our office adding any other vision care plans in the future as reimbursement rates are not sustainable for long-term growth. Anagram Access will allow us to drop plans in the future if profitability is suffering.
A Solution that Allows Patients to Continue Seeing a Doctor They Trust
Most patients have been highly receptive to Anagram Access. Our staff has done a great job explaining “open-access” and how easy it is to apply their vision benefits, even if our providers are not in-network with their plan. Loyal patients are accepting of this process, and it has allowed them to keep their eyecare with our doctors even though we are out-of-network with their managed care plan.
Most patients chose to stay with us for their services even though we are not in-network with their plan. A small number of patients still choose to use other eyecare offices that are in-network, but the vast majority are open to the idea of reimbursement and find it easier to purchase their products the same day from our office. We follow-up with patients to make sure they receive their managed care reimbursements.
A Way to Provide Quality Care While Reducing Dependency on Managed Care & Increasing Profitability
We are able to generate more revenue per patient than we would as in-network providers for certain plans, and payment is received same-day directly from the patients. We are able to use our choice of quality materials and products without restrictions from managed care plans.
This allows us to keep our patients without having to sacrifice quality. We are able to be compensated fairly for our services and don’t have to worry about stagnant reimbursement rates from managed care plans that do not increase with the rate of inflation.
We would have to see three-to-four times as many patients with certain managed care plans to generate the same revenue achievable with the open-access model. We don’t have to over-fill our schedules and over-work our staff since Anagram Access allows us to generate more revenue per patient than we would if we were in-network with some of these plans. Managed care is not sustainable in this economy, especially since reimbursement rates have been stagnant for so long.
Other Articles to Explore
Show Patients the Care You Can Provide When Not Limited By Managed Care
Anagram Access has been a great way for our office to educate patients on the realities of what their vision plan actually covers compared to usual and customary charges. Once patients understand that their costs are essentially the same with open-access versus in-network, most patients are happy to keep their care in our office with our doctors. It has eliminated some of the obstacles of being out-of-network with certain vision plans.
Patients understand that costs are rising and cheaper is not always better, and most patients are receptive to the open-access model. We are able to generate profit and focus on quality instead of quantity.
Jennifer Williams, OD, is a partner with Pelham Eye Center in Pelham, Ala. To contact her: email@example.com