California State Exchange Board Says No to Direct Participation by Stand-Alone Vision Plans

By Daniel L. Mannen, OD, FAAO September 04, 2012

Well, fall is in the air and it is time to get ready for some football. Whatever you do, if you are going to a game, be sure you remember your tickets. I remember a few years ago, driving two and a half hours to an Oregon State/Oregon civil war game—only to find out that our friends had forgotten their tickets on the kitchen table. “NO ticket, NO entry.” They were on the outside, looking in. 

On August 23, the California Health Benefit Exchange Board voted to exclude stand-alone vision plans from directly offering coverage in the California Health Benefit Exchange. Despite overwhelming optometric support, the decision was largely swayed by opposition from organized medicine which was seeking increased control of patient access. Needless to say, this should be of concern to every independent optometrist. We now face the prospect of health plans (aka: medicine) determining the extent and terms of optometric care. 

Since all vision care will have to be delivered by or in partnership with a health plan in the new California Exchange, the decision greatly advantages programs that are owned by health plans (Spectera, Davis Vision, and Kaiser) and means that stand-alone vision plans like VSP will have a harder time competing for patients. This is significant because independent optometrists may see fewer patients as people transition into the Exchanges and into plans that lock them out (like Kaiser) or that pay less (like Spectera and Davis). 

Optometry has grown and prospered largely because we have earned the right to determine our own destiny. Patients have been increasingly able to access our optometric practices directly. Optometry is and should be a primary point of entry for patients to access the health care system. Limitations on optometric participation in the new healthcare Exchanges may well threaten our hard earned autonomy. Access to patients is the key to optometric independence, and organizations like VSP Vision Care should be allowed to compete in the California Exchange and Exchanges across the country. 

I cannot overstate the importance of preserving direct optometric access to patients. My advice to my optometric colleagues:  educate yourself about healthcare reform, understand that far-reaching decisions are being made which may affect your ability to see your patients, and support stand-alone vision plan inclusion in your state insurance Exchange. The time to act is now. It will be increasingly difficult to make changes after the fact. 

As I see it, we must understand the potential significance of the California decision and use it as a wake-up call to action. Medicine seems to be driving the decision-making process and, in my opinion, it is dangerous to just assume that optometry will be treated fairly. We have not gotten to where we are today by using a strategy of passive trust; rather, optometry has fought and scrapped for every advance. As we all know, medicine has given ground very grudgingly. We must take an active role in the decision making process and not allow ourselves to end up on the outside, looking in.

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