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The NetMinder Blog

Expanding Your Vision Network With Online Retailers

Posted by Laura McMullen on Wed, Mar 28, 2018

glasses.jpgAs of October 2017, there were roughly 52,000 vision care locations that participate in at least one PPO network, in the NetMinder database. According to the Vision Council of America, 3 out of 4 Americans need glasses or contact lenses. If the population and the vision care locations were evenly spread out across the country, each location would serve about 4,800 people. Of course, they aren’t which makes the rise of online eyeglass and contact lens purveyors inevitable.

Buying glasses and contact lenses online has become simpler.

Wherever you decide to purchase your glasses and/or contact lenses, you need a prescription and an eye exam from an optometrist or ophthalmologist to get started. To buy online, you upload your prescription and other pertinent information and then move on to shopping.

When you shop online for glasses, like anything else, you can get a lot of information without going anywhere or talking to anyone. There are many more style, color, and other option choices than you’ll find in a brick-and-mortar store. And you can save money: Consumer Reports estimated savings of up to 40%. On the flip side, you could get the wrong prescription or glasses that don’t fit correctly since you might need to measure your own pupil distance. It might also be hard to return the glasses. And you might not be able to use your insurance. WebMD summarized the pros and cons of shopping for glasses online here.

Shopping for contact lenses has similar pros and cons although since disposable contact lenses have been widely available for a long time, mail order retailers, such as 1-800-contacts, have been part of the marketplace longer. Demand for lenses that change eye color and other fashionable products has grown the market further. There are more factors to consider when purchasing contact lenses in general that require the assistance of an optometrist or ophthalmologist. WebMD summarizes them here.

Can you use vision insurance when you shop for glasses or contact lenses online?

Sometimes. You can always use the funds in your FSA or HSA. Some accounts have debit cards to pay directly while other plans require reimbursement. Some online vision retailers are in-network with vision PPOs and will accept benefits while others are out-of-network and will provide a detailed receipt to support reimbursement.

We looked at some online retailers to learn about their policies. Here’s what we found:

  • A few retailers are In-network with some carriers. Members can access benefits online.
Warby Parker – glasses only
Glasses.com - glasses only
Contactsdirect - contact lenses only
  • Most online sources for glasses and contact lenses are out-of-network with all carriers.

Glasses

Felix + Iris
Eyebuydirect
Coastal - glasses and contact lenses
Classicspecs

Contact Lenses

1800contacts
Walgreens
Walmartcontacts.com

Vision insurance doesn’t get as much airtime as medical and dental insurance in general. However, a significant percentage of people with insurance have coverage. In fact, the Centers for Disease Control estimate 58% of people with private insurance have optional vision coverage and 44% of people with public insurance have optional vision coverage.

Online retailers have made inroads into the market. How do they fit with your vision network? How do you compete with other networks that include online retailers if yours doesn’t?

Tags: Vision insurance, vision networks, vision market, eyeglasses, optical retail, contact lenses

Synergies Helping the Dental and Vision Insurance Markets Work Together

Posted by Susan Donegan on Fri, Jan 26, 2018

In dental and vision insurance, the network is where the consumer experience happens. That’s why it’s important to know the network landscape and leverage all points of differentiation and separation from the competition.

First, a few definitions. These observations are based on a review of NetMinder data for the top 15 national dental PPO networks and the top 10 vision networks as of March 2015. A network is defined as a payer/plan combination, i.e. Delta Dental PPO or EyeMed Access. Counting methods are:  

  • Access Points: each provider at each location in a provider directory.  
  • Unique Providers: each provider one time regardless of the number of locations s/he is listed at in a provider directory.
  • Locations: each location one time regardless of the number of providers who are listed there in a provider directory.

AvgNetworkSize.jpgRelatively speaking, dental networks are much larger than vision networks. The supply of dentists is larger than the supply of optometrists and ophthalmologists. There are 65 dental schools vs. 23 optometry schools23 and nine dental specialties vs. two optometric specialties.

There is also greater demand for dental services:

demand_dental_vision.jpg

Download our whitepaper to learn more about these favorable trends as well as the synergies that help the dental and vision insurance markets work together. 


23 https://en.wikipedia.org/wiki/List_of_dental_schools_in_the_United_States:
24https://www.quora.com/How-long-does-a-routine-dental-checkup-normally-take-in-the-U-S-if-the-patient-is-perfectlyhealthy-and-schedules-one-every-six-months
25http://www.webmd.com/eye-health/what-to-expect-checkup-eye-exam-adults#1
26 http://health.costhelper.com/teeth-cleaning.html
27 http://eyeexamcosts.com/understanding-eye-doctor-costs/

Tags: dental insurance, Vision insurance, vision networks, dental network, access points, unique providers, provider locations, practicing locations, NetMinder, network analysis, network comparison tool

Superior Vision and Davis Vision to Merge

Posted by Laura McMullen on Thu, Oct 05, 2017

Centerbridge Partners, Superior Vision’s parent company, and HVHC, a wholly owned subsidiary of Highmark and the parent company of Davis Vision, announced two transactions in August:

  • vision.jpgCenterbridge will purchase Davis Vision, HVHC’s managed vision care subsidiary. Davis Vision will be combined with Centerbridge’s existing managed vision care portfolio company, Superior Vision. Highmark will acquire a minority ownership interest in the combined Davis Vision-Superior Vision company.
  • Centerbridge will acquire a minority equity stake in Visionworks, HVHC’s optical retail subsidiary. Highmark will retain a controlling ownership interest in Visionworks.

In 2013, Superior Vision merged with Block Vision, covering more than 8.5 million members nationwide, with a provider network surpassing 55,000 access points. Vision Monday reports that Superior Vision currently has more than 11 million members. Davis Vision reports more than 22 million members and more than 68,000 points of access including optometrists, ophthalmologists, and retailers in private practice and retail settings. 

With so many mergers taking place in the healthcare industry overall. We decided to also look at the evolution of selling dental and vision insurance as a key part of the total benefits package employers use to attract and retain top talent. Download our whitepaper, Exploring How Dental and Vision Work Together to learn more about the favorable trends as well as the synergies that help the dental and vision insurance markets work together. 

How does this new vision combination change the landscape in your territory?

Tags: Vision, vision networks, Vision insurance, optical retail

Six Synergies That Make Selling Dental and Vision Plans Together Smart

Posted by Susan Donegan on Wed, Jul 19, 2017

Beyond their similar relationship to medical plans, dental and vision plans have several other synergies.

The same components are evaluated during the dental and vision benefits sales processes: benefit, price, and network. Both products have defined benefit structures that can be compared on specific points. Rates are presented in tiers based on job classifications and number of people covered. Networks are less complex than medical plans and specific tools and processes have evolved to compare apples to apples.

The same network analysis tools can be used for both products to differentiate between networks. The sales process requires size comparisons, accessibility measurements, overlap/disruption analysis, and sometimes re-pricing analysis. network analysis pyramid.jpg

Beyond the departments that all companies have such as IT and facilities management, dental and vision plans can share functions like pricing, sales, marketing, and underwriting. Many multiline carriers have shared sales forces that use a single point-of-contact as a selling advantage. There are also departments that perform similar functions like recruiting and credentialing, where process synergies can come into play.

And, distribution strategies, like whether or not to be on an exchange, broker marketing strategies, and voluntary/worksite programs, since both products are voluntary-friendly, can be leveraged across both lines of business.

Download our whitepaper,  Exploring How Dental and Vision Work Together to learn more about the synergies that help the dental and vision insurance markets work together. 

Tags: dental network, vision networks, health insurance, healthcare benefits

A Peek At Dental and Vision Network Trends

Posted by Susan Donegan on Wed, Mar 29, 2017

In dental and vision insurance, the network is where the consumer experience happens. That’s why it’s important to know the network landscape and leverage all points of differentiation and separation from the competition.

First, a few definitions. These observations are based on a review of NetMinder data for the top 15 national dental PPO networks and the top 10 vision networks as of March 2015. A network is defined as a payer/plan combination, i.e. Delta Dental PPO or EyeMed Access. Counting methods are:  

  • Access Points: each provider at each location in a provider directory.  
  • Unique Providers: each provider one time regardless of the number of locations s/he is listed at in a provider directory.
  • Locations: each location one time regardless of the number of providers who are listed there in a provider directory.

AvgNetworkSize.jpgRelatively speaking, dental networks are much larger than vision networks. The supply of dentists is larger than the supply of optometrists and ophthalmologists. There are 65 dental schools vs. 23 optometry schools23 and nine dental specialties vs. two optometric specialties.

There is also greater demand for dental services:

demand_dental_vision.jpg

Download our whitepaper to learn more about these favorable trends as well as the synergies that help the dental and vision insurance markets work together. 


23 https://en.wikipedia.org/wiki/List_of_dental_schools_in_the_United_States:
24https://www.quora.com/How-long-does-a-routine-dental-checkup-normally-take-in-the-U-S-if-the-patient-is-perfectlyhealthy-and-schedules-one-every-six-months
25http://www.webmd.com/eye-health/what-to-expect-checkup-eye-exam-adults#1
26 http://health.costhelper.com/teeth-cleaning.html
27 http://eyeexamcosts.com/understanding-eye-doctor-costs/

Tags: dental network, vision networks, health insurance, counting method, dental provider, Vision insurance, practicing locations

Retail Chains In Vision Networks

Posted by Laura McMullen on Fri, Mar 10, 2017

I just saw an article about Walgreens piloting an optical shop at one of their stores in Chicago in Drug Store News. Walgreens already sells reading glasses and contact lenses already so why are they adding more services now? 

glasses_contacts.jpgThe vision care market is all about the materials. According to the Vision Council of America, three out of four Americans need glasses or contact lenses. The cost of glasses ranges widely depending on a consumer’s preferences and prescription. CostHelper Health reports a national average of $196 with lows starting at $8 for drugstore “cheaters” to highs of $600+ for designer frames with special lenses and coatings. All About Vision estimates that contact lenses cost “roughly $220 to $260 for a year's supply of lenses and another $150 to $200 on contact lens solutions, for a total annual cost of roughly $370 to $460 to wear contact lenses.”  

These costs make insurance attractive to consumers. The CDC estimates 58% of people with private insurance have optional vision coverage and 44% of people with public insurance have optional vision coverage. And vision networks are growing – here’s a summary of some trends that we’re seeing in NetMinder 

A unique component of vision networks is retail chains. In NetMinder, we define these chains as having at least 4 locations with or without an ophthalmologist or optometrist on site. When analyzing vision networks, we found that nearly 20% of locations in national vision networks are part of a national retail chain with the largest concentrations in the WalMart, Lenscrafters, and Vision Source brands.  

And this is where Walgreens comes in. Retail chains account for more than half of the revenue in the vision market even though they are only one-third of the locations. The brands are popular and heavily advertised and some competitors, WalMart and Target, area already in the market. Walgreens has more than 8,000 stores in the US and, as of August 2016, 76% of the US population lives within 5 miles of one.  

How does this potential new retail network affect your network? Is it a prospective partner? A competitor? 

Tags: vision market, optical retail, vision networks, Vision insurance, vision discount plans

Growth Trends Continue in Vision Networks

Posted by Laura McMullen on Thu, Jan 12, 2017

Each year, we analyze the vision network data in our database and publish the results. Take a look at what we learned last year. Like 2015, 2016 brought growth across the board in the 10 largest vision networks: more providers in more networks that look more alike.

top 10 vision 2016.jpgOver five years, access points grew the most, 50%, followed by unique providers at 32% and unique locations at 13%. Two possible reasons for the lag in location growth is that retail locations, such as big-box stores and wholesale clubs, offer more revenue with fewer providers and online options to fulfill eyeglass and contact lens prescriptions are increasing.

The average number of locations per provider remained about the same year over year – 2.36 vs. 2.32. This is probably a reflection of network consolidation: Superior Vision completed the integration of the Block Vision network late in 2016.

Another measure of growth that we’ve been tracking for several years is the number of networks the average provider participates in. On average, providers belonged to 3.6 networks in 2016, which is slightly down from 3.7 in 2015, and an increase of 17% in the last five years. Eye care providers (ECPs) belong to less than half the number of networks as dentists (8.3 networks in 2016) which is most likely another reflection of the consolidated nature of the vision market compared to the dental market.

vision per provider 2016.jpgThe final trend we analyze is the distribution of providers by the number of networks they participate in. In 2016, 35% of ECPs are in 4-6 networks while only 23% were in 2011. The shift from accepting 1-3 networks to 4-6 for ECPs leads to greater overlap between vision networks causing less disruption if employer groups opt to change networks.

How are these trends affecting your business? When you talk to ECPs, are they more interested in joining your network than they have been in the past? How are you maintaining the uniqueness of your network?

Tags: vision networks, vision market, practicing locations, Vision insurance

Focusing on vision networks

Posted by Laura McMullen on Tue, Jul 07, 2015

A few years ago, we published a whitepaper called Clearing Up the Vision Market. Since then, the demand for vision networks has increased significantly with the number of people who take a vision plan when it’s offered growing from 78% in 2012 to 83% in 2013 in a 2014 SHRM study on vision care, so we decided to take another look.

As of March 2015, there are 48,000 optical locations in the top 10 national vision networks. They fall into two categories: independent eye care professionals (ECPs) and retail chains.

  • ECPs are defined by VisionWatch as having three or fewer locations with an ophthalmologist, optometrist, an optician, or an optical retailer on site. Nearly all ECPs are small businesses.  According to a whitepaper sponsored by Vision Source, ECPs are typically single location operations with less than $1.5 million in annual revenue and 12 or fewer employees. They have been in practice on average for 20 years.
  • Retail chains have 4 or more locations and may or may not have an ophthalmologist or an optometrist on site. The best-known brands in this category are widely available, such as LensCrafters, Pearle Vision, Walmart, and Costco.

ECPs make up two-thirds of locations and 45% of market share while retail chains are the rest. A recent Bain and Company study shows the second most influential factor (after cost) in selecting a managed vision care plan is the retail network the plan provides. This helps explain why retail chains account for 55% of vision sales, with only one-third of the locations.

A Consolidating Market

In a recent Wall Street Journal blog post, Optometrists Catch FFL’s Eye, Thomas Puckett of merger and acquisition advisory firm HPC Puckett & Co., said “There aren’t many operators with over 100 locations, but there are quite a few independents with under 50 locations. It is logical for businesses to consolidate in a geographic area.”

Private equity firms are projecting that the number of retail outlets will drop by half over the next five years through consolidation. Investors are most interested in firms valued at $10 to $50 million and the expected growth from the Affordable Care Act and the aging US population makes the industry even more attractive.

Other Vision Network Trends

A recent review of the top 10 national vision networks in NetMinder found some interesting trends:

top_10_vision
  • Vision networks are growing. The number of unique providers in these networks grew about 8% annually from 2011 to 2015. Unique locations grew more slowly (3% annually) and access points grew more quickly (11% annually). This is most likely because retail chains, such as Pearl Vision or Lenscrafters, generate more revenue with fewer locations.
  • Some ECPs practice at many locations. On average, ECPs are listed in provider directories at 2.4 locations with a range of 1.6 to 3.2 locations. This could be the beginning of a trend toward overstated access in vision networks. We see about 25% access point inflation in dental PPO networks and have put a validation process in place using claim data to adjust counts. We are watching vision networks closely to see if a similar filter is needed. 
  • vision_networksECPs are joining more networks. In March 2011, the average ECP participated in 2.5 networks. By March 2015, that count was up to 3.7 networks. This shift is quite dramatic: five years ago 75% of eye care providers in these networks were in 1-3 networks and now only 53% are while 15% are in 7-10 networks.


Are you seeing these trends play out in your network? Are vision benefits in demand among your customers and their employees?

Tags: network providers, Affordable Care Act, optical retail, Vision insurance, healthcare benefits, Managed Care, employee benefits, vision networks, practicing locations, Vision

How does network leasing work in health insurance?

Posted by Laura McMullen on Thu, Mar 26, 2015

In a previous blog post, we explored the narrow network trend that began with HMOs and resurfaced on the federal and state exchanges from the Affordable Care Act. In that post we also touched on some of the new entrants into the health insurance market like co-ops and health system-based networks. This is the first of a series of posts that explores these new entrants and their network structures further.

healthinsuranceHistorically, insurance companies built and maintained their own provider networks. As the healthcare market changes, new network organizations have become more prevalent and visible and existing networks have been put to different uses. These network organizations can be categorized into six groups: network leasing companies; CO-OPs; TPAs and other cost management experts; discounters; hospitals and health systems; and accountable care organizations (ACOs).  Each of these categories has a slightly different perspective on managing provider relationships – some work closely with providers while others are at arm’s length – and it’s important to keep these differences in mind as you compare networks. This post takes a look at network leasing companies and future posts will examine the other types.

Network Leasing Companies

Many medical and dental networks use leasing partners to fill in service area gaps, meet network adequacy requirements, move into new markets, and grow their networks in general. There are two types of PPO networks that are available for lease.

Insurance companies take the financial risk for an enrollee’s medical costs and offer a network of providers who accept reduced fees for access to enrollees to control those costs. Staff at the insurance company recruit providers into the network and manage the ongoing relationships. When carriers have excess capacity in their networks, they sometimes decide to lease or swap all or part of the network to other companies. Lease arrangements earn additional revenue for insurance companies through monthly network access fees. Swaps fill in network gaps which can create a stronger sales advantage.

Examples of insurance company networks available for swap or lease:

Non-risk PPOs offer providers a fee schedule for covered services and then sell access to the network to other entities, i.e. insurance companies, employer groups, associations, unions, etc. The company offering the PPO doesn’t take the risk for the enrollee’s medical costs. The provider’s contract is with the network leasing company and the leasing entity is one step removed. The network leasing company receives a monthly network access fee for every person who can use the network, although other arrangements are possible. These arrangements are popular in medical and dental networks with standalone companies and carriers offering their networks for lease.

Examples of non-risk PPOs available for lease:

Vision networks are also leased as non-risk PPOs or offered under their own names by medical or dental carriers where the risk is taken by the vision plan. EyeMed and Block Vision are active in this space.

When leasing all or part of a network, it is important to make sure that all providers are properly contracted to offer discounts to members. When networks are “stacked,” offering multiple networks within a service area to achieve higher discounts, providers can be confused about which fee schedules are in effect. Confusion in the provider’s office can lead to member dissatisfaction if the wrong coinsurance or copay is charged which ultimately leads to lost business. When leasing, be sure your network team works closely with its counterparts in your lease partner’s organization.

How does network leasing fit into your business plan? Are you looking at new service areas? Do you have network adequacy requirements to meet?

Tags: network providers, Affordable Care Act, network leasing companies, dental PPO networks, insurance companies, vision networks, non-risk PPOs

Changing Supply and Demand for Eye Doctors

Posted by Laura McMullen on Thu, Sep 11, 2014

Recently, the American Optometric Association and the Association of Schools and Colleges of Optometry, along with a number of vision industry leaders, commissioned the Lewin Group to conduct a study of the eye care workforce and create a computer model to continuously study supply and demand for eye care providers. AOA and ASCO leaders called the study “the most ambitious, comprehensive and forward-looking study of eye care supply and demand ever undertaken” in the release announcing the study. To get the National Eye Care Workforce Study go to aoa.org/marketplace (registration and fee required).

The study reports the same three factors that are driving demand for overall healthcare services are affecting the demand for vision care services:

  • The U.S. population is aging and its vision is deteriorating.
  • Diabetes is more prevalent than ever.
  • The ACA expanded the health insurance market and required vision coverage for children.

eye drThe National Eye Care Workforce Study reports an oversupply of optometrists and ophthalmologists through 2025. However, other experts frame a shortage.

One interpretation of the current market shows the supply of eye doctors is growing to meet the increased demand:

  • The supply of eye doctors is increasing. Three new optometry schools graduated their first classes in 2013 and another one will open in Kentucky in 2016. Every year 1,350 new optometrists graduate while 420 retire, according to a presentation Richard Edlow, OD, gave at the Integrated Ophthalmic Managed Eyecare Delivery program in April 2013. Some eye doctors postponed retirement until the U.S. economy rebounded, so the retirement rate will increase as the recovery continues.
  • Eye doctors could see more patients and keep their current schedules. Optometrists surveyed by the Lewin Group as part of the study reported that they could increase patient capacity by 32%, or 933 visits, annually without adding hours or days to their schedules.

Another interpretation shows that supply shortages are on the way while demand is growing:

  • More women are becoming eye doctors. “Fifty percent of ophthalmology residents are female, and 64% of optometry graduates are female,” Dr. Edlow said in his presentation. “Every study indicates that women work about 85% of a full-time employee. If we take this into account, we have 51,000 eye doctors, and we’re going to need 65,000.”
  • Eye doctors are working fewer hours. Most work 40 hours weekly as opposed to 50-60 hours weekly in the past.

The National Eye Care Workforce Study provides a snapshot of the current situation overview and also created a computer model to evaluate the workforce at future points in time. As time goes on and other factors come into play, the supply and demand picture will ebb and flow.

According to NetMinder, the industry standard for vision provider network comparisons, managed vision networks continue to grow, indicating strong demand from consumers and employers for access to vision care.

What do you see in your business?

Tags: NetMinder, vision market, Vision insurance, ACA, consumer choice, network comparisons, vision networks

 

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