Eye Care International, Inc., is ophthalmology's most recent attempt to offer discounted eye care services without becoming more deeply mired in managed care. Too many health plans still do not include an eye-care component, say ECI representatives, and those that do rarely offer access to ophthalmologists and elective surgical procedures such as LASIK. In the last 12 months, ECI has grown to include almost 14,000 provider locations and more than 12 million possible memberships in a variety of health plans.

The Business Model
President and CEO of Eye Care International, Clark Marcus, believes that ECI's no-paperwork, payment-at-time-of-service model is attractive to physicians. Providers who meet ECI's credentialing criteria are admitted to a network of ophthalmologists and optometrists who agree to offer their services at a discount. This is typically 20 percent below the Medicare-allowable for all coded procedures to non-Medicare eligible patients and 20 percent off usual and customary fees for all non-coded (elective) procedures (e.g. LASIK). There is no charge to the health-care provider to be a part of the ECI network.

The Concept
ECI was conceived in 1993 when Mr. Marcus met with several ophthalmologist friends at a meeting of the American Academy of Ophthalmology. "We were talking about how managed care is not going to be able to keep pace with the visual needs of aging baby boomers," he recounts.
 
"We know the aging body demands medical attention. We wanted to create a plan to go beyond discounts on eyewear." For this reason, the ECI founders were adamant about creating a discount vision-care plan that would include both ophthalmology and optometry. "We knew this idea would not appeal to some," Mr. Marcus notes, "and we knew that it would take certain types of people who were comfortable with the concept to make it succeed. But there was no question about the need for such a plan from the public's point of view." Regarding the participating physicians, he continues, "They understand the concept that in order to get back patients they were losing, they had to coalesce and provide the patient with quality care at affordable prices."

"ECI found a 'hole' in the market," explains New York's Herbert Gould, MD, one of the surgeons with whom Mr. Marcus consulted when constructing ECI. "Unlike insurance companies that do not cover eye care, ECI comprises ophthalmic surgery and optometric care."

Warren Cross, MD, of Houston was another of the brainstorming ophthalmologists behind ECI. "I thought a discount vision-care plan would be good for ophthalmologists because it would give more people access to surgical and medical eyecare. It would be good for optometrists, because it would put them in a position to dispense more glasses and contact lenses," he points out. Dr. Cross says that it's also convenient for patients to have their MDs and their ODs in the same network, in case a comanagement situation exists.

"The whole idea of ECI is for patients to have access to surgical eye care … at a price they can afford," emphasizes Dr. Cross. "It's a free-enterprise way to open access to eye care to many people," he adds, "without socialized medicine or government interference."

A Practice-builder
Patients interested in non-covered services that ophthalmologists may provide such as LASIK, cosmetic surgery or Botox injections might seek out ECI-participating ophthalmologists for the 20-percent discount. "ECI provides us a new coterie of possible patients," imparts Dr. Gould. He says that the potential traffic driven to a physician in the very competitive area of refractive surgery alone is reason enough to sign up for ECI. "When you think about how much we have to spend on advertising in the refractive surgery business," he reasons, "the opportunity to get a number of potential patients on a silver platter through the ECI network completely balances our advertising budget."

Rick Abrahamson, MD, of Cincinnati and his father, Ira Abrahamson, MD, were also part of the creative group behind ECI. Dr. Rick Abrahamson says that his participation in the ECI network has been invaluable in the growth of his practice. "I get between five and eight new patients per week who are directed to me by the ECI network," he estimates. With ECI, he says, there is no administrative burden on his front desk. "There's no paperwork on my end. When people come in, they just present their ECI card, they get the discount price, and they pay cash for their service," he says, adding that he has dropped most of the other vision plans because of the referrals and phone calls that need to be placed.

Houston's Dr. Cross calls participation in ECI a practice-builder. "Some practices that are strategically located next to a plant or a large company that contracts with ECI could get an inflow of patients that could almost be overwhelming," he guesses. And, they'd all be paying up-front for services. Being a part of the ECI network, says Dr. Cross, "is part of being responsible and responsive to the health-care needs of people in our community. Not everybody can afford to buy, nor can every company afford to offer, eye insurance policies. If this discount plan allows an employer to offer ECI at a low cost to them, it allows us to provide better eye care."

ECI Members
According to Mr. Marcus, ECI is structured to be privately labeled. As such, it does not market directly to the public, but to businesses and health-care plans. Some members' cards will show the ECI logo, but others will not. A quick call to ECI's 800-number can confirm a patient's eligibility for discounts, he reports.

Among ECI's newest accounts, Mr. Marcus includes the retail department store chain, Macy's East. "Employees of about 101 Macy's stores who have a health-care plan have ECI as their vision component," he estimates. Grace Sells, a benefits manager in Macy's Midtown Manhattan office, relates that Macy's chose ECI as its vision plan for its reasonable cost to both the employee and to Macy's. "We did not have an eye-care provision in our health plan, but now we are pleased to be able to offer our associates ECI as an option in their benefits package," she says.

Devon Health Services Inc., of Pennsylvania, also recently began including ECI as the vision-care component of its health plans. "What we really liked about ECI more than other vision plans," relates Leonard Day, national sales manager, "is their good concentration of ophthalmologists. We see the strength of ECI on the surgery side of things, the availability of LASIK and other elective procedures not generally covered by most insurance."

Other Benefits
Mr. Marcus says that because of the strong bargaining position of the ECI network of physicians, the company has arranged with a major professional and business insurance brokerage to offer ECI's providers business insurance at reduced group rates, including employer's liability insurance and malpractice coverage. Ophthalmology and optometry practices that dispense can get best-column pricing on all frames and lenses. "Our providers with dispensaries can get prices as competitive as those usually offered only to the largest chains in the country," offers Mr. Marcus. 

Visit ecivisionplan.com or call 1 (800) 324-7483.