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When health care is driving toward team-based delivery, what happens when you’re not on that team?” asked EyeCare Advice’s Jackson, implying that optometrists need to join in or be left out. By definition, ACOs are groups, organizations of specialists led by a primary care physician or hospital system. You can no longer stay alone on “eyecare island,” as Jackson puts it in his book, The Value-Driven Eye Care Game.

This also means that although it is possible but challenging to do so as a sole practitioner, joining an ACO will most likely be as a networked group of optometrists, according to most of those involved who spoke with Vision Monday.

“Individual optometrists will not be of interest to ACOs,” said 4PatientCare’s Guterman. “ACOs will contract with organizations that bring a network of optometrists into the ACO.”


Among the eight essential elements of an accountable care organization, a culture of teamwork is of prime importance. Reprinted with permission from the AOA’s “Accountable Care Guide.”

This is one reason that Vision Source is among the groups of optometrists uniquely positioned to join ACOs, according to Jim Greenwood, president and CEO of the Texas-based national optometric alliance. “We have networks of optometrists in 50 states with strong local leadership. We can have the leader sit down with these systems and understand what their needs and workflow requirements are and then lead our members to deliver a solution that addresses that need,” he said. “A prime example is Memorial Hermann Health System, a leading nonprofit in southeast Texas. They filed a new medical insurance plan with the state of Texas in October 2013, and Vision Source members will be the provider of eye-care for that medical plan.”

Another group, EyeHome Network is a health services organization that is developing national integrated networks of optometrists and ophthalmologists, with the intent of optimizing eyecare delivery to its payers (health plans, medical groups, ACOs, self-funded employers) and their members.

“It’s too complex,” said OD Excellence’s Jim Grue, OD, about going it alone. “You can’t do it on your own unless you spend every weekend going to conferences.”

 
 
Still, some do say that independent optometrists can join ACOs on their own, such as Stephen Montaquila, OD, chair of the AOA’s Third Party Center Executive Committee, who said, “I’m working with an ACO to develop a collaborative care group. The ultimate goal is to have a large group, but they are willing to bring in individuals one by one. Harvey Richman, OD, of Shore Family Eyecare in Manasquan, N.J., is one of our members invited to join as an individual.”

Already involved with two ACOs in New Jersey (Geisinger Health System and Partners in Primary Care) Richman is currently looking to join two more. Participating as a specialist, he does not benefit from the shared savings or additional profits. Although “both are fairly new,” he said, he has already seen an increase in patients. While he observed, “My business model stays the same, but the change is forcing me to change,” he is, “absolutely joining more ACOs.”

Whether to go it alone or as a group also depends on the ACO. “I’m working with a patient-centered home in Akron, Ohio, that’s very small and happy with one or two optometric locations,” said OD Excellence’s Sude, “but I’m also dealing with an ACO with 175 physicians that wants at least 15 locations to handle 550 eye exams per month.” ■