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How Will ACA Affect Managed Vision Care Network Models?

Posted by Aaron Groffman on Tue, Aug 13, 2013

As healthcare reform continues to take shape and the market becomes even more consumer-centric, insurance companies need to make sure their networks are in line with what customers want. The Patient Protection and Affordable Care Act (ACA) will create new market opportunities  both inside and outside of exchanges  for vision providers and insurers.

For example, the public exchanges will require all medical plans to include pediatric vision coverage, potentially increasing the number of people who will get regular vision exams. On the other hand, ACA could mean that standalone vision plans will appear more often outside of the exchanges because public exchanges might exclude ancillary plans. Voluntary vision coverage tends to be a popular benefit with employees, however, so it’s unlikely that these plans will be going away anytime soon.

What types of plans do consumers prefer? Our research shows that managed vision care plans have to include a mix of independent eye care professionals (ECPs) and retail chains in order to win over consumers. So the next questions are: how are they currently achieving this balance and what are the most common network models?

The three primary types of network models in managed vision care are:

  • Flat organizations contract primarily with ECPs and a limited number of the smaller chains;
  • Vertically integrated organizations, whose networks include their own retail stores as well as ECPs and other retail chains;
  • Hybrid networks have more of an even distribution between ECPs and retail chains

To determine which approach makes the most sense for each managed vision care network, the planning process needs to account for the ACA’s impact (which seems to favor ECPs) and the growing corrective materials market (which seems to favor retail chains).

To learn more about managed vision network models, watch our free webinar: Clearing Up the Vision Market.

Tags: Affordable Care Act, vision market, Vision, Vision insurance, healthcare reform, Managed Care

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