Managed Vision Care Perspectives on Reimbursement

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Managed vision care companies are weighing whether or not to reimburse for ocular telemedicine exams and other services. Most are still undecided.

VM asked representatives from four leading managed vision care organizations to share their views on the subject.

“Telehealth remains an ongoing topic of NAVCP (National Association of Vision Care Plans) board discussion as well as with our industry stakeholders, such as eye care professional and retail organizations. We have yet to develop a formal position on the topic due to constant introduction of new technology and the rapidly expanding number of options for patients and eye care professionals. As you might imagine, these emerging technology solutions provide different opportunities and challenges to each of our members based on their individual business models.

“What I can say is that NAVCP supports the use of telemedicine/telehealth vision care consultations provided that accepted clinical standards are met, a licensed eyecare professional is directly involved in administering treatment and vision care where patients have choice and transparency in the use of services.”—Julian Roberts, executive director, National Association of Vision Care Plans

“We believe there is room for telehealth in today’s healthcare marketplace, but it must keep in place the role a licensed optometrist plays in promoting eye health and diagnosing and treating ocular diseases.

“VSP does not reimburse for any online vision tests, but we continue to evaluate how telehealth might offer opportunities to increase access to care for remote or underserved communities and extend the patient-doctor relationship.

“As telehealth technology advances, it’s critical that it includes appropriate standards of care and regulatory oversight to protect a patient’s health, safety and privacy.—Mary Anne Murphy, OD, vice chair of VSP Global’s board of directors

“UnitedHealthcare was among the first vision plans to enable for access to telemedicine for eye exams, using the same clinical standards, provider reimbursement and coverage policies as for in-person appointments. Our decision to expand plan coverage for telemedicine is one way we are encouraging the use and development of these technologies, building on UnitedHealthcare’s broader focus on innovation and mobile resources to improve access to quality care.

“Telemedicine is a valuable option when access to traditional eye care is limited or not available, especially for people with certain chronic health conditions. Telemedicine exams must meet our clinical expectations and quality requirements, including the appropriate use of technology and provider involvement for each component of the exam.

“UnitedHealtcare is actively evaluating the development of telemedicine providers, devices, and artificial intelligence, while eye care providers are beginning to embrace this technology as a way to better serve patients. UnitedHealthcare continues to support the expanded use of telemedicine and mobile technologies, including the development of pilots to evaluate consumer and provider preferences and clinical efficacy, with the goal of helping encourage access to quality care that can be more convenient and affordable.—John Ryan, General Manager, UnitedHealthcare Vision

Kirk Rothrock, chief executive officer of Versant Health, which manages the Davis and Superior Vision care plans, told VM’s Mark Tosh, the managed vision care firm is “keeping a very close eye on the tools and technologies that are being made available” to patients seeking eye exams, but has not yet included any of the new tools in its coverage plans. “It’s proven in virtually every other aspect of health care delivery that there is an appropriate place for telehealth, whether it’s reaching rural populations, holding down the costs or increasing the frequency of interactions that a patient may have with the health care system,” he said. “We absolutely believe in telehealth as a component.”

Still, he said there are still questions about which of the new telehealth tools in the eyecare space have demonstrated medical efficacy.

“We would like to support telehealth, but I don’t think that we should be the arbiters of what is and what is not… of appropriate clinical quality. But we are supportive and we are staying close to it,” he added.

Rothrock said he believes the Centers for Medicare and Medicaid Services (CMS) does a very good job of evaluating new tools, new techniques and new procedures in health care and, as a result, he is “inclined to defer to CMS on the decisions” of what to approve with respect to specific telehealth tools or processes in eyecare.

“When they do,” he added, “we will certainly welcome telehealth- administered exams into the system and we will certainly be prepared to reimburse providers for doing that. But I think it would be inappropriate for us to be the judge and jury on what that is.”

He also noted that while ECPs are concerned about losing patients in the office to telehealth exams, another way to view this is by considering the diabetic patient who needs to have visual acuity checks on a frequent basis. “What if [the diabetic patient] goes to their eyecare professional twice a year and gets a telehealth checkup the other 10 months of the year? They are actually using the health care system more and we are more effectively managing their health than if telehealth didn’t exist.”