Managed Care

Adapting to a New World By Dropping Vision Plans: How to Do it Successfully

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By Nicolas Gilberg, OD

Oct. 28, 2020

People and businesses alike are being forced to adapt to unpredictable and transformative circumstances this year. I’ve seen it from big businesses to small practices— including how the forces at work in 2020 are affecting eyecare providers.

Look at the big picture: Twitter’s employees are allowed to work from home forever, and you’ve probably had a get-together with family or friends via Zoom this year. We’re doing things differently. While the changes brought by the coronavirus pandemic are significant, they’re not the only developments forcing ECPs to adapt.

I’ve seen it first hand: Faced with unique and challenging situations, some ECPs are doing more than acclimate—they’re growing! One way they have been adapting is by evaluating the managed vision plans their practice accepts, and whether each (or any) of these plans makes financial sense for the practice.

How ECPs Are Adapting to Industry Changes
Amid the pandemic we’re all reflecting on opportunities to implement changes. At Nealberg Consulting Group, we transitioned from an exclusive global health-care company focus to also helping ECPs adjust to the rapidly changing circumstances of the industry in 2020. The pandemic increased costs of doing business for ECPs. Social distancing slows down patient flow and means more time per patient. And disinfection protocols are increasing costs.

As a result, many are deciding to join others in dropping vision care plans and are learning how to function without them. This requires, among other things, the use of new technologies to enable qualitative yet affordable patient acquisition.

After all, what’s the main benefit of the vision plans you’re in-network with? The free patient acquisition, of course.

But is it really free? Think about it: If you’re in-network, then you’re contracted to accept a certain amount—often less than your customary fee. Let’s say you usually charge $100 for a routine exam, but a vision-plan referred patient generates a contracted amount of $50.

You essentially paid a vision plan $50 for a new patient. Wouldn’t it be better to pay Google $20 to acquire an out-of-network patient and net $80 in profit?

It’s cost-effective, out-of-network patient acquisition like this that’s giving practices room to breathe, and even grow, this year— and beyond.

Is Dropping One or More Vision Plans Right for Your Practice?
With Nealberg Consulting Group, I often help practices drop vision plans and lower patient acquisition costs in the process. And one thing you should know ahead of time: Dropping one or more vision plans is not right for every practice. You need a marketing plan to capture new patients, a communication strategy to retain existing ones and software to make the transition out-of-network easier.

Do you feel up to dedicating time to executing on your marketing plan? Are you looking for a cost-effective way to grow your practice? Then going out-of-network may be right for you.

It’s natural to go for the low hanging fruit that are vision-plan directories. Whether you’re a new graduate opening cold or a more seasoned professional, most health-care providers share the same issue: The need to bring in patients to generate revenue. It’s a do or die situation usually made worse by difficult-to-manage overhead.

It’s how the rat race starts: You set yourself up to be forced to generate revenue. The instinct is to enroll in as many medical insurances and vision plans as possible to have the maximum number of patients. In turn, to see all those patients a practice needs more staff, more space, more equipment, more billing time. The overhead increases and so does the incentive to see more patients.

The result is competing providers forced to see low-paying HMO or vision plans to feed the monster they’ve created. The alternative? Don’t use vision plans to compensate for the lack of a marketing plan. Vision plans are not a marketing tool and should not be used as such.

Using Marketing for Low-Cost, Out-of-Network Patients
Developing a marketing plan that will help you lower acquisition cost with out-of-network patients starts with careful thinking about your practice brand and messaging.

Ask yourself who you are as a practice, as a provider. What is the practice identity? What is the brand? What are the differentiators? Why would a new patient come to see you out-of-network instead of choosing someone in the vision-plan directory? Why would long-term patients stay with you if you drop their plans?

People think of marketing only as choosing a communication channel. Every provider should first choose a message and then work on spreading the word. You need to create your brand story—then and only then you can think about marketing channels to communicate that message.

Maybe people will come see you because you carry a specific frame line. Maybe they will come because they want a luxury office. Maybe because you have a heavy focus on pediatric care. You need to identify why they come see you and tell others.

Crafting your Digital Marketing Plan
This is such a broad topic, but it needs to be addressed. We are in the 21st century. Times have changed. Having a high-traffic physical location is not enough.

Someone might see your practice, but rest assured they will go online to check you out. Your digital identity should reflect that. Every step of the acquisition cycle should be looked at and improved. To drive traffic to your web site, you should use a multifaceted approach:

  • Organic (natural) search engine indexing
  • On-page- and off-page search engine optimization (SEO)
  • Paid advertising (Facebook, Google AdWords, Instagram)
  • Blog posts

SEO is a specialized and costly skill. Many companies promise doctors SEO, but do not deliver. Good SEO relies heavily on engaging, exclusive content. Use some of your free time to write articles and blog posts on your web site. If you have been successful with the previous step, patients will eventually land there.

It’s difficult to be a good critic of your own practice, so I will help you: Many, if not most, optometry web sites look bad. That’s because many providers rely on companies that build white-label web sites that are outdated, visually awful and lack functionalities. What’s worse, their pay-per-month model is expensive in the long run. Stop paying $300 every month. Pay $5,000 to $10,000 once for a custom web site and be done with it.

Your web site should be up to date, both aesthetically and functionally. That means features such as online appointment booking with a platform like Square or buying contact lenses with a solution like Dr. Contact Lens.

Once prospects have done their research on your web site, we reach the stage where patient acquisition conversion happens. Patients should make an appointment online or call your office.

Here we have to address a core issue: Patients will mostly likely ask you if you take their vision plans. If you dropped vision plans, the answer should be “Yes, we do accept it as an out of network/open access provider.” Every office that decides to drop vision plans needs a solution to look up patients’ out-of-network benefits.

Converting Out-of-Network Patients
Anagram is another tool I’ve found helpful as ECPs transition out-of-network. It’s a software solution that instantly finds and details patients’ out-of-network benefits. You may decide to do that ahead of time or during the patient visit. Anagram will tell you the allowance for the exams and materials for most vision plans.

Best of all, it will file the claim in a few clicks. Patients hate two things: Not knowing what they are going to spend and paperwork. Anagram solves those two issues. Patients will pay the office directly and will receive a check in the mail for the benefit amount.

In my office experience, this is when the magic happens. Showing patients the actual numbers gives them reassurance and gives you legitimacy. Before we started using Anagram, we would convert roughly 50 percent of patients who contacted us—the other half went elsewhere because we would not accept their vision plans. Since we implemented Anagram, our conversion rate for those patients is close to 90 percent.

This makes the transition out of network easier, freeing up time for you to focus on building a marketing plan instead of vision plan administration.

It’s something I’m seeing over and over this year: ECPs looking for an alternative to the current model. And more often than not, they choose to drop vision plans and start selling themselves instead. If it’s right for your practice, there’s certainly a path toward practice growth out-of-network. Especially in 2020.

With your message in place, help from online appointment-booking technology, an up-to-date web site and Anagram in place, you can profitably carry your practice into this new era.

Nicolas Gilberg, OD, is the owner of Dr. Gilberg & Associates and a consultant with the Nealberg Consulting Group. To contact him:



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