Just what the doctor ordered

EyeMed enters medical and surgical benefits segment with CareMore

EyeMed checked another item off the eyeDo list in September when we launched a medical and surgical vision care solution forCareMore Health Plan, a Medicare Advantage plan that’s part of Anthem.  The solution is on track to go live on January 1, 2018.

Under the new model, which will serve approximately 20,000 members in the Tucson/Phoenix and Las Vegas metropolitan areas, EyeMed will manage a single network for routine vision care, medical eye care and eye care surgery in an effort to improve continuity of care for members and simplify processes for the client and network providers.  The new model will make EyeMed the largest industry player with the ability to manage all aspects of eye care for our health plan clients, solidifying our positioning as the partner of choice for them.

Network providers will now be able to provide in-network services to the full scope of their licenses—including treatment of medical conditions of the eye and even surgeries. And, being able to perform routine vision care and medical services on the same day of service is good for both providers and members. EyeMed benefits by bringing our expertise in vision care to more clients and members.

“Through our partnership with CareMore, we’re delivering on the product of the future, today,” explains Hector Rincon, vice president, product and strategy. “Providing the full range of vision care offerings from routine to surgical care on the same day of service means members can get complete, in-network vision care service all in one place. This makes members and clients happy and allows network providers to use their licenses to the fullest – a winning solution for all our constituents.”

Launching this new model was possible thanks to the diligent and quick work of the following teams:

  1. IT and product teams—leveraged the new Facets platform to enable us to manage services for more than 800 procedures vs. what used to be only 50 for routine vision care.
  2. Provider relations team—recruited new ophthalmologists and launched a new utilization management program to make sure members get appropriate care when facing eye conditions like macular degeneration and cataracts.
  3. Operations and call centers—acquired new skills to be able to pay more complex claims and answer questions related to “medical” conditions, like medical exams and surgery.

We look forward to expanding medical/surgical offerings with other resellers in 2018.

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