This article is more than 5 years old. Information may no longer be current.
Alliance allows vision care network to track practitioners' prescribing habits
Click Here to Manage Email Alerts
--- Donald A. Hood, OD
DENVER—The Eye Health Network (EHN) has announced an exclusive alliance with a pharmacy benefits manager that will provide the network with pharmaceutical tracking ability.
EHN has joined with PhyNet, a subsidiary of Express Scripts Inc., the largest independently owned pharmacy benefits manager in the country, said Donald A. Hood, OD, president and chief executive officer of EHN.
Hood said Express Scripts covers 10 million lives, has alliances with one-third of the hospitals in the United States and is on-line to 95% of the U.S. HMOs. PhyNet is a marketing arm of Express Scripts and it was created to market the new alliance.
Hood says EHN, with its network of 13,000 ODs and 4,000 MDs, has been able to offer HMOs routine vision and medical/ surgical services, and the alliance now allows it "to also manage the pharmacy portion of our eye care carve-outs," he said.
Enables effective tracking
The alliance will enable EHN to effectively track the prescribing habits of its members, Hood said.
"I'll know every prescription that the optometrists and ophthalmologists in the Eye Health Network have written," he said. "I have been able to show the HMOs how cost-effective we are on the professional side, such as how many times we see a patient. Now I can also show them how effective we are on the pharmacy side. It's pretty exciting."
Hood said this feature makes EHN more competitive with networks who provide eye care services for less but prescribe much more. "HMOs know this, but they've had no way to track it," he said. "Now we can track it specifically with our providers and guarantee compliance to the HMO's formulary."
The HMOs tend to track big-ticket items such as MRI use and cardiology care, Hood said. "There just haven't been the resources to devote to tracking eye care. If we can bring that savings to an HMO—even if it is half a million dollars instead of a million dollars—then that's something they will look at."
Hood said EHN will be able to show the total dollars spent on drugs for glaucoma, iritis, red eyes, etc., and these figures will give him a good deal of ammunition when negotiating with HMOs, as long as the network is cost effective.
Helps providers stay within standards
Hood said this information will also "be able to help providers to stay within the standard of practice within their community." He said EHN is in the process of implementing this with payers.
Express Scripts also owns Practice Pattern Sciences (PPS), a disease state outcome company, and the alliance integrates EHN with PPS. This will enable EHN to also track diseases, Hood said.
"It enters us into the mainstream medical profession in disease state management and prevention," he said.
While Express Scripts has its own routine eye network, it does not have medical/surgical services. As part of the alliance, EHN will now pick up the medical/surgical part of Express Scripts' routine customers, as well as continuing to offer its own routine vision plan.
"That was a challenge for me, because we didn't want to abandon our own networks," Hood said.