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Impact on Vision Providers November 2010 National Healthcare Reform.

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Presentation on theme: "Impact on Vision Providers November 2010 National Healthcare Reform."— Presentation transcript:

1 Impact on Vision Providers November 2010 National Healthcare Reform

2 Reform in Review President signed H.R into law on March 23 rd. (Patient Protection and Affordable Care Act - PPACA) President signed H.R into law on March 30 th. (Healthcare and Education Reconciliation Act) Parts of legislation scheduled to roll out yearly between 2010 and 2019.

3 Reform in Review What is included – Coverage Expansion Coverage expansion to 32M additional $940B est. Individual Mandate Requires all citizens have health insurance beginning 2014 Employer Responsibilities No employer mandate for employer w/under 200 employees but… Employers w/+50 employees assessed a penalty if any employees receive premium credit through an exchange Must auto enroll employees who do not select or opt out – Delivery System Reforms – Revenue Provisions What is not included – Cost containment – Employer Mandates – Tort Reform/Liability Protection

4 Coverage Expansions Public Program Expansions Medicaid eligibility up to 133% of FPL States prohibited from reducing current benefit levels to offset cost of additional members High risk pools Medicare Improvements Plug donut hole in Part D State Exchanges

5 Stand alone vision not a mandated inclusion Probable that they may be included at states option Separate exchanges for individuals and employer groups Administration must be self sustaining thru state assessments Standard sets of benefits

6 Delivery System Reforms Requirements for Transparency Healthcare costs Medical loss ratio 85% for large group/80% for small group and individual Reporting begins 2010/Rebates begin 2011 Premium review Administrative simplification Development and use of uniform explanation of coverage documents Development of standardized definitions

7 Delivery System Reforms Consumer protections Choice of primary care provider Mandatory coverage of ER visits w/out prior authorization Federally defined minimum qualified coverage (Sept provisions) No cost sharing for preventive services No denial of coverage based on pre-existing conditions No life time or annual limits Extend dependent coverage to age 26

8 Revenue Provisions Reduce pharma payments & increase access to generics Reduce Medicare/Medicaid fraud Reduce hospital readmissions through bundled payments under Medicare Assessments on RX drug manufacturers, medical device manufactures, health insurance companies, and diagnostic labs Expand P4P programs Excise tax on Cadillac health plans (2018) Medicare surtax on upper income citizens (2013) Additional penalties on non-medical HSA/HRA withdrawals (2011) Increase threshold for itemized medical deductions from 7.5% to 10% of income (2013) Sin taxes (indoor tanning 2010) Reduce Medicare Advantage funding

9 Revenue Provisions

10 Impact on Vision Provider non-discrimination provision (Section 2706) Enhanced vision coverage through pediatric vision exam requirement (2014) Vision exam but not eyewear will be a mandate coverage for children under % medical device tax beginning 2013 Specifically excludes eyeglass and contact lenses Value of stand alone vision plans not included in calculation of Cadillac coverage (2018) Dilate optometric scope of practice

11 Impact on Vision OTC products no longer an allowable expense for HSA or FSA spending (2011) Contact lenses, solutions, readers, and refractive surgery still allowed Limit on FSA contribution (2013) SCHIP programs maintained thru 2019 Exchanges and Cadillac tax likely to accelerate adoption of HDHPs HDHP members w/ HSA, HRA or limited FSA show higher than average rate of vision care use Accelerated health plan consolidation Reduced vision coverage under Medicare Advantage plans

12 Medicare Advantage Enhancements Share of Medicare Advantage Plans with Selected Extra Benefits 2010 Vision exams - 86% Hearing tests - 65% Worldwide coverage - 62% Preventive dental - 55% Extra podiatry benefits - 47% Extra chiropractic benefits - 34% Some transportation - 14% Part B premium rebate - 6% Source: Medicare Advantage 2010 Data Spotlight, Kaiser Family Foundation

13 Accountable Care Organizations Medicare demo project In 2012 providers will be allowed to organized as ACOs Must be led by physicians or hospitals Must manage full spectrum of care Accountable for the overall cost and quality of care for a defined patient population Must follow clinical guidelines and have quality measured continuously Must provide care across all care settings

14 Accountable Care Organizations Four organization models Network Organized Medical Group Hospital Collaborative Two reimbursement models Total risk model Shared savings model

15 Accountable Care Organizations Key strategies Integrate care management and engage patient Identify preventable events Reconfigure care to reduce, waste, and harm to patient Anticipate impacts include Accelerate hospitals employment of physicians Accelerate clinical integration Reduce private practice delivery options

16 Impact on ECP as Small Employer Small Business Tax Credit 35% tax credit of health care premiums Fewer than 25 employees Average wages of less than $50K Employer must pay 50% or greater of employee only premium cost Can include cost of dental and vision premiums Available 2010 thru 2013 Advise to talk with a benefits consultant Wellness Program Grants Fewer than 100 employees Program must not have existed prior to 3/23/10

17 Impact on ECP as Small Employer Exchanges (2014) Small Business Health Options Program (SHOP) Run by state Available to employers with up to 100 FT employees After 2017 may also be opened to larger employers

18 Impact on ECP as Small Employer 1099 Filing Requirement (2012) Must file a 1099 form with IRS for any vendor from whom you purchase property or services worth $600 or more during the calendar year

19 What Next? – Implementation! Varying interpretations Promulgation of rules through multiple agencies Stakeholder advocacy will continue at federal and state agency level Public comment periods Question of agency authority to address Items beyond agency authority will require additional legislation to fix Compliance enforcement

20 2010 Elections Impact? Total repeal unlikely Obama veto power Portions already enacted Federal Level Action Require multiple hearings Stall funding Adjustments 1099 requirement Definition of grandfathered plans Delay Medicare Advantage cuts State Level Action Limit scope of exchanges Impede expansion of Medicaid Drop out of Federal Medicaid/SCHIP program Join legal challenges

21 Prepare Now! Stay alert to developments nationally and locally Contact local ASOs and other integrated care organizations for inclusion Express opinions and concerns to your elected representatives Work with industry advocacy groups Advocacy is Key to Promote Quality Vision Care If you dont tell your story, someone else will tell it for you!

22 Prepare Now! Consult with your business professionals Accountant Benefits consultant Update your practice Delegate to staff so you can practice to the full scope of licensure Adopt an EHR Develop an effective, professional web site Align with strong business partners such as Essilor

23 The Essilor Partnership Essilor and IHMS Commitment - Supporting the Eye Care Professional Grow Your Business Employer strategy Other strategies Run Your Business Provide Managed Care expertise

24 CONSUMERS LAB ECPs /Retailers LENSFRAMES Essilors Traditional Focus

25 Large Self-Funded EMPLOYER/PURCHASER Medium/Small (Broker) Government Business Coalition/ Affiliations Consumers: Members & Workers Health Insurers ( HMO / PPO ) Vision Plan Dental/Vision Plan Combo LABECPs LENSFRAMES Expanded View

26 The IHMS Team Steve Nussbaumer VP IHMS Barbara Heffez-Piper Director - Cross-Channel Operations Terri Nesrsta Regional Director- Central Gail Tarantino Regional Director- West Jessica Sumner Assistant Colleen Gelb Plan Specialist Optum Health Superior Vision Opticare Mike Monaco Regional Director- East Maria Barnwell Director-Business Development Raphael Varisella Plan Specialist VSP CompBenefits Christelle Broize Project Manager Alyssa Baker Plan Specialist EyeMed Avesis VBA EyeMed Humana (CompBenefits) VBA Advantica Medicare / Medicaid VSP Superior Vision Anthem BCBS (WellPoint) Optum Health (Spectera) Davis Vision Avesis Vision NVA Opticare Medicare / Medicaid Military Kaiser Employer initiatives Strategic Accounts Red Solosko Director-Marketing Matt Wood Marketing Associate Kristie Miller Marketing Manager Steven Fales Marketing ssociate

27 Employer Program What They Want? Reduced healthcare costs 99.4% of top decision makers are concerned with the impact of health care costs (2010 UBA Employer Opinion Survey) Tactics employed Minimize employee health risk Shift costs to employee 80% will spend money on health promotion and wellness in 2011 Majority express frustration with the ROI Desire to increase employee engagement rates So What? Opportunity to leverage Vision Care as a program that: Increases employee engagement, Improves health outcomes Reduces healthcare utilization

28 What is the Employer Program? A strategy that ties the eye exam to reduced health care costs and risks Provides frequent and direct messaging to large pools of people Grows utilization of eye exam and hardware

29 Health Fair Program Events Attended 200k+ Employees Impacted 10 Trade Shows Attended 100K

30 Vision Wellness Brochures What: A set of 6 topical (vision-related) information sheets you can use to build interest and initiate a dialogue on vision coverage with a target employer Topics: 1. Vision & the Aging Workforce 2. Vision for a Healthy Workplace 3. Eye Safety at Work and Play 4. The Road to Better Health 5. Vision Disorders in Children 6. Computer Vision Syndrome

31 CUSTOM Logo

32 Think About Your Eyes Direct to consumer messaging – importance of comprehensive eye exams TV, radio, online and social media communications 2 year campaign Focused on nine cities – New York, Los Angeles, Chicago, Denver, Atlanta, Houston, Sacramento, Cincinnati, and Portland To date has generated more than million impressions.

33 Think About Your Eyes Events New York – May 24-30, 2010 Chicago – July 19-25, 2010

34 Essilor Vision Foundation A public charity whose mission is to eliminate poor vision and its lifelong consequences starting with children Provides free eye exams and new prescription eyewear through in- school and partnership programs to children who cannot get them otherwise Educates parents, teachers, caregivers, and community leaders to be aware of the implications of poor vision and watch for signs of vision problems in children Educates children on importance of vision care and proper care for eyewear

35 Hot Off the Presses A Path to Wellness – A white paper by KDD Health Solutions Analyzed 3 years of medical claims for a company of 10,000 employees & dependents 62% higher

36 Strategies For Sustainable Environment Assistance to Run Your Business thru: Managed Care Plan Expertise Webinar Training

37 Run Your Business Practice Assessment Development to: Increase Capture Rate and Traffic Reaching out to new customers Internet presence Retaining current customers Increase Practice Profitability Dispensing techniques Staff training on plans Pricing strategy Frame board optimization Report Trend Analysis

38 Conclusion Managed care will continue to be highly important to independent optometry Healthcare reform will keep things exciting for the foreseeable future Recommendation: Find the right advisors to partner with during this turbulent time, and STICK WITH THEM.

39 Terri Nesrsta (214) For more information please contact your Essilor Sales Rep or: Ken Allmer (801) Matt Swartz District Sales Manager (480)

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