SARATOGA, Calif.— VisionCare Ophthalmic Technologies, Inc., a developer of advanced visual prosthetic devices, said that the Centers for Medicare and Medicaid Services (CMS) has granted transitional pass-through payment status and established a billing code for the implantable miniature telescope under the Hospital Outpatient Prospective Payment System. The new pass-through code, C1840, is effective Oct. 1, 2011 and will enable outpatient facilities to obtain reimbursement for the telescope implant for covered procedures.

The telescope implant is approved by the U.S. Food and Drug Administration to improve vision in patients with end-stage age-related macular degeneration (AMD), the most advanced form of AMD. Eligible patients must have associated central vision blindness and either stopped responding to AMD medications, or have a form of the disease for which no treatment is available.

“These are very positive developments for AMD patients and the ophthalmology community,” said Allen W. Hill, CEO of VisionCare. “The new code will provide a payment mechanism for the telescope implant for Medicare beneficiaries visually debilitated by end-stage AMD. We are training providers and working with the ophthalmic community so that eligible patients can begin receiving treatment next month.”

The first-of-kind telescope implant is integral to a new patient care program, CentraSight, for patients with end-stage macular degeneration. The CentraSight treatment program involves a patient management process and access to reimbursement information for patients and physicians. The telescope implantation is performed by a specially trained ophthalmic surgeon as an outpatient procedure. More information is posted at www.CentraSight.com.

Implant in situ

The challenges involved in developing an implantable optical device to give sight back to sufferers of end-stage age-related macular degeneration (AMD) are nothing short of immense. Not only must developers understand the disease and create a device that will bring maximum benefit to the patient, there are biocompatibility and sterility issues to address – plus of course the key issue of how to implant the device into the eye itself.

But following a clinical trial involving more than 200 patients at 28 leading ophthalmology clinics across the US and now with the all important FDA approval under its belt, VisionCare Ophthalmic Technologies, a privately held specialty medical device company based in California, is finally in a position to offer end-stage AMD patients its implantable telescope technology.

“Our device is the first of its kind. It is the first FDA-approved implantable medical device demonstrated to improve visual acuity and quality of life in individuals with end-stage AMD,” Chet Kumar, VisionCare’s VP of business and market development, told optics.org. “There is truly an un-met need for these patients as no drugs or surgical procedures are available to reverse the effects of macular degeneration.”

What is end-stage AMD?
A healthy eye uses several elements, such as the lens at its front, and the light-sensitive retina at its rear, to provide clear vision. Packed with a high density of light-sensitive cells, the macula is a small area of the retina that produces the highest-resolution images used for central vision. AMD is a disease of the macula that leads to varying levels of central vision loss.

In the case of end-stage AMD, a patient will suffer from complete central vision blindness, which is permanent as currently there is no way to repair the macula. Estimates suggest that as many as 750,000 people in the US are currently suffering from end-stage AMD, living with a central blind spot in both eyes.

Fortunately, the cells that are responsible for peripheral vision – albeit at a lower resolution than central vision – are not attacked by AMD. And this is what VisionCare exploits with its implantable telescope technology. “In the simplest terms, our device helps patients to see by projecting the central image around the degenerated macula instead of on to it, thus utilizing healthier, preferred retinal photoreceptors,” explained Eli Aharoni, the VP of research and development and general manager of VisionCare Ltd.

Getting started
VisionCare was founded in Israel in 1997 to commercialize the implantable telescope technology that was the brainchild of an ophthalmologist called Isaac Lipshitz and prolific inventor Yossi Gross. In 2000, the company restructured and moved its headquarters to the US, where it is now led by president and CEO Allen Hill. Its research and manufacturing activities remain in Israel and are headed up by Eli Aharoni. To date, the company has raised a total of $59 million in venture capital funding.

As Aharoni explains, simply knowing where to start was a major difficulty. “The initial challenges were in understanding the disease and then how to build a device that can meet the patient’s needs,” he said. “We had to consider many optical parameters, the mechanical engineering to produce the device to tight tolerances, the biocompatibility of our materials and their sterility and stability inside the eye. The final task was to develop a surgical procedure to implant it in the eye, which was a challenge requiring coordination between both engineers and surgeons.”

Implantable device

The optics involved
VisionCare’s implantable telescope projects an image that would normally be destined for the damaged macula onto healthy retinal cells instead. However, as cells in this peripheral retinal location generate images at a lower resolution, it is essential to magnify the image.

“Unfortunately, if you take any image and magnify it, the field of view decreases,” commented Aharoni. “When we magnify the image on to the retina, instead of having the naturally wide field of view of a normal eye, people have a limited and smaller field of view. A normal eye has a detection field of view of anywhere between 90 to 130 degrees, not necessarily all at high resolution. Our two telescope platforms are wide-angle, offering a magnification of 2.2x and 3x with a relatively large field of view of 24 degrees and 20 degrees, respectively.”

To enable patients to compensate for the peripheral retina being used for central vision, VisionCare only implants its telescope technology into one eye. The implanted eye restores the patient’s central vision, while the untreated eye retains peripheral vision for mobility and orientation. Although this sounds disconcerting, patients are reported to adapt within a few weeks.

The telescope is implanted in an outpatient procedure and involves removing the eye’s natural lens. “The patient’s natural lens focuses images onto the macula, but in end-stage AMD, the macula is no longer functioning and providing central vision,” explained Kumar. “The telescope implant is surgically placed in the capsular bag after the lens has been removed. We essentially use the space where that natural lens was to secure the telescope implant.”

Measuring just 3.6 mm in diameter, the implantable telescope is essentially a telephoto device that, in combination with the cornea, creates a telescopic effect that magnifies objects in view. The device is composed of a sealed glass capsule which contains all of the bi-convex and bi-concave convergent and divergent micro-lenses confined within air pockets to create a magnified image on the retina.

“Our manufacturing process is unique to our company,” commented Aharoni. “Everything is done in a Class 10 clean room. We have developed special machines and processes that allow us to produce the devices with micron-level precision.”

Image magnification

Clinical trials
VisionCare has now completed two clinical trials. An initial trial ran from 2000 to 2002, while the pivotal clinical trial started in 2003 and led to the recent FDA approval. This trial involved many high profile and leading ophthalmology institutions, including the Johns Hopkins University, the Massachusetts Eye and Ear Infirmary and the Wills Eye Institute in Philadelphia.

“The pivotal trial showed that we can improve visual acuity on the eye chart; improve a patient’s quality of life because of the vision we can give back, and finally that the telescope can be implanted safely,” commented Kumar. “We have long-term data with patients five years down the line post-surgery. That’s why the FDA ophthalmic devices advisory panel unanimously recommended our technology for approval.”

Ophthalmologists involved in the study also sing the praises of the implantable telescope technology. “Despite the past decade of advancements in macular degeneration therapies, retina specialists still did not have a treatment for the many wet- and dry-AMD patients who progressed to end-stage disease,” said Julia Haller, Ophthalmologist-in-Chief of the Wills Eye Institute. “Starting today, we can provide these patients with new hope.”

“This is truly a breakthrough technology for AMD patients as their treatment options have been limited until now,” added Kathryn Colby, an ophthalmic surgeon at the Massachusetts Eye and Ear Infirmary. “The clinical results from the pivotal FDA trial have proved that we can place this tiny telescope prosthesis inside the eye to help patients see better and, for some, even to levels at which they can recognize people and facial expressions that they could not before.”

According to Kumar, many ophthalmic institutes are now interested in becoming treatment centers. Here, the patient would undergo a strict screening process to ensure that they would benefit from the devices before having surgery. Centers would also provide post-operative care and training on how to adapt to the new levels of vision. “We initially plan to launch across the US, and then expand to Europe and beyond,” commented Kumar.

Profile view - schematic

What the patients say
So, what has been the reaction of the patients who have received the sight-restoring treatment? Kumar says that they often recount how difficult life was before they had the surgery, especially in social and dynamic activities, and how much of a difference the implant has made. “For example, some patients have said, before I had this, I wasn’t able to see your face,” he commented. “In terms of the implant only being in one eye, some patients have explained that you just adapt over time and eventually don’t think about it. With these patients, neither eye has a functioning macula, so there is no permanent way around the blind spot. Even though the image in one eye is bigger than the other, they have commented that it just becomes natural – a goal of Eli’s and [testament to] his engineering team’s efforts.”

About the Author
Jacqueline Hewett is a freelance science and technology journalist based in Bristol, UK.

OVERLAND PARK, KS – Working through an extensive network of preferred laboratories, Spectrum Vision Systems, Inc., a two-year-old preferred provider organization (PPO) has built a provider base of 2,300 independent practitioners, giving it the largest PPO provider base in the U.S., according to Paul Disser, chairman of the board, president, and CEO.

The organization also currently has 70 contracts with wholesalers, representing 160 locations in 40 states.

“We are the only PPO with such depth and breadth of contractual relationships with wholesalers,” Disser says. “We work in concert with these labs to identify strong practices in a specific geographic area.”

Spectrum works through closed panels of providers. The number of prospective patients in a given area determines the number of ODs asked to participate in the plan, according to Disser. Ninety percent of Spectrum’s providers are ODs, while 10% are ophthalmologists and opticians.

Currently, the company has 50,000 cardholders, whose families are also eligible for Spectrum benefits. It is too early to track cardholder utilization rate, Disser says, because the company did not start selling memberships until March of this year and has not had a chance to complete a year’s cycle of active marketing.

One of Spectrum’s strong suits is the optical industry experience of its executives, Disser notes. “Two of our top management people (Robert Feher, executive vice president, and Jack Rudd, vice president) have 50 years combined experience at the wholesale and retail level,” he says.

“This means we have the expertise to address the needs and concerns of the independent practitioner. In addition, we have done something that no other PPO has done, and that is to marry optical experts and experts in the benefits field in our management team.”

The provider is the lynch pin of the organization, Disser says. In putting together its payment formula for members, which consists of the wholesale cost of the product plus a dispensing fee, Spectrum considered the needs and sensitivities of its provider base.

“We did extensive research at the lab and retail level in working out a formula that would yield a benefit to both the patient and the doctor,” he says.

In general, providers are content to work with Spectrum’s wholesaler network because “these labs represent the cream-of-the-crop,” Disser says. In turn, the labs serve as a quality control mechanism, ensuring high product standards and informing Spectrum if a provider has a high incidence of re dos.

One provider, Jerry Padfield, OD, Garnett, KS, says, “Working with approved labs is fine with me, because those are the labs I was working with anyway.”

Another provider, however, Alvin Pollack, OD, St. Louis, MO, is less enthusiastic.

“I feel working with approved labs is an imposition because you are locked into a price,” he says. “I might be able to get a lesser price.”

Spectrum’s members include financial institutions, unions, and insurance companies such as The Travelers Companies, Telecredit Marketing Services, Inc., and the Missouri Automobile Dealers Association. In addition, Spectrum works through third party administrators.

Companies that are considering signing contracts with Spectrum generally ask for documentation of its utilization rate, Disser says.

Spectrum Providers’ Labs Form Advisory Panels

OVERLAND PARK, KS – In an effort to incorporate the needs of its providers and approved labs more fully into its administration, Spectrum Vision Systems, Inc., will create two seven member boards of providers and lab principals.

The plan has been approved and adopted by the organization’s board of directors and will be implemented no later than the end of the year, according to Paul Disser, chairman of the board, president, and CEO.

“The boards’ role will be to serve as advisors to Spectrum concerning fees and benefits,” he says.

Vision care, once considered the “stepchild” of the employee benefits family, is that no more. Although it has grown through the years to be considered a much-desired peripheral product, the marketing penetration remains relatively low, thus representing a viable and popular product-service to offer clients and prospects. Especially for younger p-c agents, offering vision care is a door-opening plan which can–and often does–lead to the sale of other insurance coverages.

Vision care is always rated at or near the top of the list of benefits most desired. This is so, and will continue to be so, because the vast majority of Americans wear eyeglasses or contact lenses and, of those who don’t, many are in need of vision care or someday will be.

Vision care plans afford agents an opportunity to stand out from the crowd which, in turn, often–if not usually–leads to making what has proven to be a relatively easy sale.

And, in seeking vision care providers, agents are strongly advised to concentrate on those who offer a nationwide network of eye care professionals who dispense eyewear to plan members in their community at savings as much as 60 percent over retail. What’s more, such providers should be able to furnish one card for the entire family, with no restrictions, and with members being free to choose any doctor within a vast provider network.

Our research indicates that over 160 million people in the United States need corrective vision products, 70 percent of whom do not now have vision care benefits. Think how attractive such a package will be when you provide it to clients and prospects.

Vision care, offered through preferred provider organizations, known as PPOs, is a complete turnkey plan, with all the legwork being done for agents and their clientele. There’s no risk. No paperwork. Just profits.

The key points that are relevant to any vision program (or, in fact, to any benefits program) are:

* The provider’s length of time in business.
* Competency and accessibility of the provider network.
* Professional staff capabilities.
* Turnaround time on any claims submitted.
* Good communications materials–information that’s attractive and easy to understand.

Also, agents who are interested to the point that they will further investigate the vision care market with an eye on possibly adding the product-service to their portfolio should determine whether the vision care provider has a system that:

* Serves not only the needs of the large vision market, but one that is flexible enough to grow and evolve as the market changes.
* Enables the client to cut costs and save dollars and pass those savings on to the consumer.
* Provides correct and quick data to the customer which, in turn, enables the organization to better manage its business.
* Provides customer service with ease of administration, and with no questions to be answered or concerns to be addressed.

As you’ve undoubtedly noticed, today’s consumer is much more sophisticated. Consumers are looking for answers and they’re looking for solutions to their problems. Health care itself is broadening in its scope in terms of what have come to be considered as basic health care rights. And, just about always nowadays, clients and prospects are looking for value-added benefits. Vision care provides them with many of those benefits and features already mentioned.

What any agent–through an established vision care provider–should be able to furnish is a user friendly package that can be applied across a broad spectrum of users: insurance company clientele, financial institution credit card customers, association members, Fortune 500 companies, and small- and mid-sized companies. This package should include an up-to-date, computerized administrative system supported by a phone system that serves virtually day and night the needs of the various memberships.

What those enrolled in vision care plans of established providers especially like is the system’s easy administration. Users are provided with a toll-free 1-800 number, then simply go to their local provider for the prescription for their glasses and their lenses, and receive a discount. So it’s a plan that’s easy to use, and it doesn’t make members “jump through hoops” to get their benefits.

Also, doctors who have signed on as members of preferred provider vision care networks have commented that they often hear from patients who say that with their vision care plan, the patients are able to choose the exact type of frames or contact lenses that best suits their needs.

This enables the doctors to provide them with an outline of what is available and what their out-of-pocket (and discounted) cost will be. In turn, this means that the doctor’s cost in terms of administering the service are much lower, and with much less paperwork for them to fill out.

As is hopefully apparent by now, the provision of vision care benefits is a “win-win” situation for everyone–agents, those enrolled in the plan, the PPOs, and the doctors within the providing networks. In addition, it’s very important for agents to know that since there is no risk transfer or insurance element in the discount card benefit, the cost is very low: $6 to $12 per year per employee.

Variations can be built in which allow for routine eye examinations with the optical discounts, and can be designed within the employer’s budgetary considerations–for example, by managing the frequency of employee’s use of their benefits to once every 12 months or every 24 months. Also, it can be managed by scheduling the level of reimbursements for exams, frames and lenses. Such plans range in cost from $2 to $12 per month per employee.

Earlier, it was mentioned that the marketing penetration of vision care benefits is–at least for now–relatively low. Specifically, our research indicates it’s less than 35 percent among the nation’s workforce. This represents some 150 million people in the workforce 17 years and older, nearly 64 percent of whom wear eyeglasses or contact lenses. And, not so incidentally, some $3 billion is spent annually on eye examinations, and it is estimated that vision care expenditures will increase 10 to 12 percent annually through the year 2010.

Bottom line–for those p-c agents who might want to consider cross selling vision care, there are these two salient selling facts: the majority of adults (and many children) in this country wear or are in need of corrective lenses; and a vision care plan will not only prove extremely beneficial to the employer and employee, but it’s a low-cost coverage that will save them money via discount offerings.

The citing of both these facts always, in our experience, garners the undivided attention of the client or prospect.

By the way, there’s something else for p-c agents to eye concerning vision care. P-c agents and their life-health counterparts should also keep in mind, and relay to clients and prospects, that every state enforces some standard for visual acuity (sharpness of drivers).

About three-quarters of U.S. states have set a minimum of 20/40 vision in the better eye with best correction.

What this means is that your clients and prospects can read at 20 feet away the same thing on an eye chart that someone with normal vision can read at 40 feet. Therefore, you can wear eyeglasses or contact lenses if you need them to pass the driver’s eye test. However, this also means that you must wear them every time you drive.

But if your clients/prospects fail the test, according to optometrists, that means that they’ll probably need to have their lenses updated.

This is yet another major reason–considering the millions of drivers in this country–that agents should cite to their clients and prospects in promoting the need for vision care benefits.

CEO, Spectrum Vision Systems
Overland Park, Kansas

Spread the word. There’s a new generation that is progressive, forward-thinking, and inquisitive about millennium benefits. The age-old “what’s in it for me?” query, while still–as it always will be–at the top of the list of concerns among insurers, agents and brokers, is now often quickly followed by yet another question:

“What other innovations can you come up with that we can offer?” In answer, there’s now an exclusive offering, in the form of a significant additional benefit to the vision care field, that definitely represents a positive answer to what many industry marketers and their clients and prospects have increasingly requested in recent year…specifically, the addition of eye laser surgery–and its thoroughly modern techniques-to the benefits package.

This elective procedure, representing voluntary surgery, is being offered at discounts of 10 to 25 percent from the usual and customary fee structure and through PPOs that include networks of independent ophthalmologists. The addition of laser surgical techniques, in the news frequently in recent years, will mean not only vastly improved eyesight for many, but the newfound ability to discard eyewear, whether glasses or contact lenses, entirely!

This represents a medical breakthrough of significant proportions. More than 150 million Americans wear corrective lenses; that’s nearly half of the U.S. population! The addition of laser surgery to the benefits package finally answers the requests of many, partly because there haven’t been many innovations in the vision care field for the past five years.

No product or service, no matter how attractive and popular, can afford to remain stagnate. Anything good can always be improved upon. Through extensive research, coupled with needed marketing acumen, that is exactly what’s transpiring in the vision field.

Undoubtedly spurred in great part by a new generation that doesn’t mind-in fact, welcomes-the change issue, and thriving on new and innovative techniques and technological changes, the benefits industry is now a whole new world.

Faced with this growing realization, it behooves benefits providers and all others involved in marketing and providing products to change some of their traditional thinking, and work in unison with people with whom they may have had adversarial relationships. Doctors of optometry and MDs are getting together to work in the co-management of patient situations. Even opticians are getting involved in these relationships on a more conciliatory basis. So we’re seeing more changes across-the-board concerning not only the benefits industry and the people offering benefits, but the organizations providing the benefits.

Again, it’s a whole new world and it’s time to buckle up … it’s going to be a challenging and exciting ride into the new millennium.

Vision care as an ancillary product has been growing in popularity through the years as an enhancement and valuable add-on to the primary package being sold, whether group life or health, standard disability income, dental, long-term care, etc. According to the findings of industry surveys, vision is always near the top of the list of benefits requested by employees. It has therefore become attractive to a growing number of companies, agencies and brokerages.

It comes with no fuss, no underwriting, no risk exposure…and at a fraction of the cost associated with the typical underwritten product. Yet the profit potential of vision plans is significant relative to a typical underwritten product.

The majority of the growth within the vision care marketplace has come about through offerings of the previously mentioned PPOs and their networks of independent optometrists. Such networks provide a large volume of business, often on a nationwide basis. For 90 percent of the U.S. population, vision care network providers are no further than a 20-minute drive.

Within the vision care benefits growth scenario, discount access card plans have grown dramatically. Typically, these plans allow members to access a provider network to garner savings on frames, lenses and contacts. And, because all is predetermined–and therefore there is no insurance risk exposure element in the discount card benefit design–the cost is very low…from $6 to $12 per year per employee. Furthermore, this type of plan is easy to install and administer, thereby boosting profitability.

There are also variations of the vision care offering that allow for routine eye examinations and discounts on optical goods, as well as the latest innovation–discounts on laser surgery. These plans can be designed with employers’ budgetary considerations in mind by managing the frequency that employees can use their vision benefits. For example, employees can visit providers once every 12 or 24 months, and the level of reimbursement for exams, frames and lenses can be scheduled (e.g., $40 for exams, $30 for frames, $30 for lenses). Typically, these plans range in cost from $2 to $12 per month per employee. The initial laser surgery benefit is being structured around a traditional PPO discount formula. Ultimately, surgery benefit reimbursements will evolve just as they have for exams, frames, lenses and contacts.

Vision care coverage is not only popular, but its features and benefits are plentiful, and it is extremely low cost. Therefore, it has not only proven an excellent add-on benefit, but it can serve–and often has–as a door opener to the sale of other insurance coverages. This is often possible because, although vision care has continued to grow in popularity through the years, many small-, mid- and large-size employers have yet to offer this attractive benefit. The marketing penetration for vision is less than 35 percent in the U.S. labor force and less than 25 percent among the general population, according to surveys by such organizations as A. Foster Higgins and Associates. So the market is definitely there.

It’s a market that includes businesses of all sizes, municipalities, various ancillary groups and countless associations. All represent new sales and revenue opportunities within a receptive and ever-growing marketplace.

The companies that continue to succeed in the vision care marketplace are inevitably the same ones that have found the right match in network development and maintenance, internal operating systems and procedures, marketing and fulfillment materials, and top-notch customer service. And that means they’ve found the right PPO.

Every step of the way along the marketing trail, such successful companies continue to stress to their agencies and brokerages that, after the sale is made, all the servicing is handled by the PPO … a fact that, with certainty, is “music to the ears” of agents and brokers.

And now, with the extremely valuable addition of laser surgery to the benefits package, even more doors–some which may have been considered closed–can be opened by those with the marketing savvy to offer vision care.

Paul J. Disser is chairman, CEO and president of Spectrum Vision Systems, Inc., Overland Park, KS, a managed care vision care company and PPO servicing over 20,000 companies and 4 million subscribers througlwut the United States, Puerto Rico and the LJ .S. Virgin Islands.

It has been said that none of us now are what we have been. And for many of us, a combination of hard work and inspiration from the success stories of others may have paid off handsomely. Or, within other scenarios, because of poor decisions some may still be struggling. Yet barring unexpected tragedy – and sometimes even despite it – many will eventually succeed.

According to the latest U.S. Census Bureau statistics, there are 280 million people in our great nation. What they all have in common is a need for our products and services – a need that can – and often does – change. Again, none of us now are what we have been. What’s important today maybe wasn’t even thought about yesterday.

And so it goes – spring follows winter, to be replaced by summer, then fall, and it’s back to winter again. We keep at it, one season following another, in our chosen profession – it’s what we do. Some do it better than others. Most are honest, while some are not. Within the insurance industry, as in any other, there’s a normal mix of individuals. Many are competent and trustworthy, while a minority are quite the opposite.

I’ll never forget a story that an insurance editor shared with me many years ago. He was covering a meeting featuring a keynote address on truth-in-advertising by the late Senator Philip Hart (D-Michigan). The senator had just introduced legislation to make this dream come true. During his talk, an insurance agent leaned over to whisper to the editor (thinking he was a fellow agent), “This guy is dangerous!”

Advertising, of course, comes in many forms. Yet word-of-mouth advertising – as you’ve undoubtedly heard and possibly experienced – has often proven to be the most effective. But it’s sometimes spread – with once being too often – sprinkled with falsehoods, often within an attractive environment conducive to sales. Then, once the deal is sealed, it’s time to move on to other waiting, and sometimes even greener, pastures.

As vision care providers for over three decades, Spectrum has heard about and at times haven’t been able to bid on business because of chicanery. The field of dreams turns into a land of dishonesty and greed for unscrupulous sellers. The buyer suffers and, when and if the word gets out, so does the industry. Sound familiar? If you’ve been an insurance and/or financial services marketer for more than a while, it undoubtedly does, regardless of what products and services you’re offering or plan to offer.

It’s also not news to industry veterans that some products are better than others and, when they’re practically equal in benefits and features, price can – and should – make the difference. Yet there’s the hitch. You can sell practically anything at any time if you tell the prospect what he or she wants to hear.

As some have rationalized and continue to act on, what’s a bit of embellishment if you get what you’re after? But they’re not salespeople; rather, they are executioners – killing softly with their words. And such individuals, through devious practices, continue to shatter the image of an industry that has long been in need of repair. Yet the refurbishing can’t be effective and lead to cleansed avenues while the mischievous among us continue to traffic in deceit.

A relatively recent case in point, one of too many we seem to be reading or hearing about, concerns an enforcement action in California, part of a statewide sweep targeting insurance agents selling unlawful and fraudulent securities. Some 100 individuals – the majority of them agents and none of whom were licensed to sell securities in the state – face charges of selling over $8 million in unqualified, nonexempt promissory notes, real estate, investment agreements, and investment contracts to more than 180 Californians.

Such reported abuse of trust, sparked by age-old greed linked to the magnetic lure of big commissions, is not only a gross disservice to the unsuspecting but also to the vast majority of honest and conscientious professionals within out ranks and to the very industry we serve.

On the proverbial, brighter, side of the coin, our organization, possibly like yours, has saved companies benefits-budget dollars every time we have had an opportunity to replace an existing program. And we’ve been able to do the same for state, city, and county governments – and, in the government sector, the savings actually represent our tax dollars!

We recently quoted a union case where we are saving the laborers $150,000 a year for identical vision benefits. When the trustees asked us how we could do this, since their “consultant” had told them another plan was the only game in town, I advised them to ask that person where he conducts his discussions with the provider. The trustees were informed the confabs occurred when the consultant-broker took them golfing, or treated them to seats in a skybox at the ballpark for baseball and football games.

Yes, it takes money to make money, but at such an exorbitant outlay? And did the consultant know that an identical plan could have been offered for less money? The answer is a definite maybe; you are invited to draw your own conclusions.

But, before you do – that is, if you haven’t already – remember that any successful consultant or marketer has studied the marketplace beforehand and knows what products and services are out there before proceeding on the pathway to profit. And, for some, if there are advantages to be derived by hiding facts, so be it – as long as they get what they’re after. As noted in this particular example, as long as entertaining can lead to financially draining others – unbeknownst, of course, to the soon-to-be client.

Please don’t misread. I’ve been around long enough to realize that countless business deals are struck on the golf course and at leisure spots. But I’ve also been around long enough to understand that, at times, the public we serve is getting blindsided by some dastardly people – look again, if you can stand the sight, at the investment houses where high-priced thieves have been removed from their dens of deceit and incarcerated.

Yes, their sordid and manipulative machinations don’t – or hopefully don’t – pertain to any of us. They have done wrong and paying for it (with others seemingly destined to follow). Yet what about us? What are we doing to rid our industry of the bad apples in our barrel?

Have we notified our peers, our industry associations, state insurance departments, and/or the NAIC when we have proof that the actions of others are most definitely askew? Or have we simply shrugged our shoulders? Think about it – and, as you do, if the concerns I’ve outlined may sound a bit pious and self-serving to you, that’s most definitely not the intent. Rather, it’s to emphasize that what’s really important in our professional lives is how we serve our clients and our industry.

Whistle blowing, while it may not have been part of our practice in all the years many of us have been in business, is sometimes absolutely needed. All you have to do is pucker your lips and blow. Blow as many of the unethical within our ranks away as much as possible – the sooner, the better. And continue to do so as much as necessary.

No, none of us are what we have been. We should be, as long as we’ve performed honestly and professionally, much better. And we can – and should – strive to continue to improve each day, each step along the way, in our journey through life. Let it be said of us, from this day forward and after we’re gone, that we served with integrity and that we honored our profession and industry.

Paul J. Disser is chairman, CEO, and president of Spectrum Vision Systems Inc, a managed vision care organization and PPO headquartered in Kansas, which services more than 20,000 companies and four million subscribers throughout the United States, Puerto Rico, and the U.S. Virgin Islands. Disser can be reached at 913-451-1672 (email, pjdisser@preferredvisioncare.com).

Star date 12/08/2003:  President George W. Bush signs Public Law 108.173, otherwise known as The Medicare Prescription Drug Improvement and Modernization Act of 2003 or MMA’03.  Although the media focus of attention on MMA’03 has been on the prescription drug benefits provided to seniors and certain categories of individuals with disabilities, another provision of MMA’03 under Title XII, Section 1201 of the Act, allowed for the creation of Health Savings Accounts (HSA’s) and co-incident tax advantages associated with consumer directed high deductible insurance plans.*

In June of 2006, it will have been 2 1/2 years since MMA’03 legislation was enacted.  In that time, over four million HSA/CDHC plans have been established.  According to financial services research and consulting firm Celent, “…HSA’s will generate 15 million new accounts and $62 billion assets under management by 2010.”**  The pace, undoubtedly, will pick up as employers, both intermediate sized (100-500 employees) as well as larger sized (>1,000 employees) begin to offer HSA/CDHC options as a way to control exploding employer benefits costs.

Although it is still too soon to determine the long term impact of this legislation, pundits are already lining up on the sides they hope will prevail.  For example, some proponents of the HSA/CDHC concept point to the fact that a number of enrollees in HSA’s come from the ranks of the previously uninsured due to the fact that they can now afford to buy the less expensive high deductible insurance plans.  This is logical when you consider that 70% of the insured population never has occasion to use their health insurance beyond their deductible anyway.  According to a CSHSC report, “…70% of covered employees had healthcare costs of less than $1,000 a year…”.  This statistic is consistent with historical utilization data which is, in turn, supported by tax return data including the level of itemized deductions for healthcare expenses in excess of 7.5% of adjusted gross income.  In other words, for an individual making the real median household income level of $43,318, household health expenditures would need to be equal to or greater than $3,248.85 (7.5% x $43,318) in order to qualify as an itemized deduction.  This is more than three times the level of healthcare costs as reported by the 70% of employees studied above.  Even a poverty-level family of four would need more than $1,300 in medical expenses in order to itemize.

Other articles, writers, editorial content seem to want to influence their readers that HSA’s are not living up to their hype.  By stating that HSA buyers are less than pleased with the outcomes designed into the HSA/CDHC plan, these editors are suggesting that the consumer was ignorant of the product he/she was buying; this is disingenuous at best and editorially dishonest at worst.  “Surveys” that suggest that, given a choice, people would choose a more robust medical plan with lower deductibles, less out of pocket exposure, and paid for entirely by someone else are an insult to our intelligence.  Given the “choice” I’d rather be driving a Bentley Continental Flying Spur with handcrafted leather interior, all-wheel drive and a turbo-charged 6 liter, 12 cylinder engine capable of 195 mph paid for entirely by someone else.  (Next time, I’ll be more circumspect in my choice of employers and benefit options.)

We decided to analyze our own block of HSA-converted business to determine if the early return NET affect was consistent with the original hypothesis, i.e., HSA’s would lower up-front, fixed cost premium expense while building longer term savings, NET of medical expenses under the deductible corridor.  The tables below illustrate averages in the categories according to our experience in the HSA market since December 2003:

In effect, what we see is this:  Over the 2.5 year period from January 2004 to June 2006, with normal utilization levels, the “average” family that converted from a traditional $500 Deductible Major Medical Plan to an HSA/CDHC $5,000 Deductible Plan has a gross outlay of $12,598 vs. $42,349 for the Traditional Plan or a gross savings of $29,751.  When you add in the savings from the HSA component of $6500 ($12,500 HSA Contribution – $6,000 Deductible Expenses from 2004 – June, 2006) you are in an HSA.2.5.net position of $36,251.  Spread this net savings of $36,251 over the 2.5 year period in question and you get annualized savings of $14,500.

To get the real impact of this concept take just one half of the savings ($14,500 x ½ = $7250) derived from our small sampling and apply it to the larger HSA market of 4,000,000 subscribers (4 million X $7250 = $29 billion).  That’s $29 Billion.  That’s a lot of cheeseburgers … or new shoes … or new paint and wallpaper in the dining room … or trips to Disney World.

Now extrapolate this savings out to the number of HSA accounts projected by Celent mentioned earlier (15 million X $7250 = $109 billion).  $109 Billion!!  Even more burgers!!!  But still less than 6% of a $2 trillion U.S. Health Care Budget.

When you are talking about Health Care in the United States, the macro-economic issues go beyond the comprehension of most citizens who are really only interested in their own micro-economic health care costs in their own micro-cosm of the universe.  But even at the micro-level, savings of approximately $600/mo/family to $1250/mo/family is something not to be ignored.

* CMS Legislative Summary, April 2004, Summery of HR1 Medicare Prescription Drug Improvement and Modernization Act of 2003.  Public Law 108-173

**Insurance Marketing Fourth Quarter 2005, p. 12

Paul J. Disser is Chairman of the Board and CEO of Spectrum Benefits Management Corporation, a benefits consulting company. Spectrum also has interests in real estate, trademarks, software and other intellectual property.  Mr. Disser has served in this capacity since he founded Spectrum in 1987.  Disser can be reached at 913-451-1672, pjdisser@preferredvisioncare.com.



Further positive news is that LVC surgery has been added to the vision care benefits package by at least one provider, with many more sure to follow.

Vision care has long been near the top of the list of voluntary benefits most requested by employees, according to the findings of countless employee benefit surveys. Now, it seems destined to become even more favored by employers and employees alike. Offering eye laser surgery on an elective and discount basis will answer the requests of many vision care members, and will undoubtedly prove equally appealing to many of your clients and prospects who currently do not have the coverage.

For agents who haven’t as yet added vision care to their portfolio, there’s no better time to do so than now. Vision, always a relatively easy sale, has now been made an even easier product to market.

This product can—and does—serve as both a valuable add-on to the core product being sold (whether it be life/health, disability, long-term care, dental or whatever), and as an effective door-opener that can—and does—often lead to sales of other coverages.

The offering includes eyewear, exams, and optical goods on a discount basis. The LVC surgery benefit, initially being offered with a 10 to 25 percent discount, is structured around a traditional preferred provider organization (PPO) discount formula. Eventually, benefit reimbursements for eye laser surgery will evolve just as they have for the other mentioned benefits in the package.

Vision care products fit the PPO concept, and so vision care discount card plans are also a major— and significant—part of the offering, with no insurance element or risk transfer in the benefit. So, once the sale is made, vision becomes a complete turnkey plan, and there’s no risk, no underwriting, nor any paperwork for the agent.

Discount card plans allow those with vision care benefits to access nationwide and regional networks of independent optometrists, who can provide a substantial savings on eye exams, frames and lenses, including contact lenses. The networks have been set up in such a way that, for 90 percent of the nation’s populace, preferred providers can be found no more than a 20-minute drive from all vision care members.

Vision care is also extremely low-cost—a fact that, not surprisingly, is always of interest to prospective buyers. Some vision plans are as low as $12 to $18 per year per employee.

Variations can be designed in the employer’s budgetary considerations; this being accomplished by managing the frequency of employees’ use of their vision benefits. For example, if the insureds go about once every year or two, the cost for exams, frames, and lenses can be about $40 for exams, $30 for frames, $30 for lenses. Such plans typically range in cost from $2 to $12 per month per employee.

Also, the current marketing penetration for vision is low. It’s less than 25 percent among the general population, and less than 35 percent in the U.S. labor force, according to surveys by A. Foster Higgins, Hewitt Associates, and LIMRA International.

These relatively low figures can possibly be attributed to vision care being rarely considered, if thought about at all, by many agents. Whatever the reason, but as apparent, there’s considerable marketing terrain to explore for those agents savvy enough to do so. It includes marketing the coverage to businesses of all sizes (large, mid-size, and small employer group plans), and to municipalities, school districts, associations, and various other affinity groups.

Mention vision to those within any of these business disciplines and usually, if not always, you’ll have their attention. And that’s because so many can identify with the need…yet, as mentioned, so few have the coverage.

What has especially brought home the need for vision care is the growing requests and desires of employees, the lifeblood of any business. And the requests of vision care members among their number has resulted in the introduction/addition of eye laser surgery to the benefits package.

There are lessons within for companies, agents, brokers—indeed, for any and all industry marketers:

• Any product/service, no matter how successful, can always be made better.

• Industry marketers, no matter how successful, should always listen to their clients/prospects … and they shouldn’t always be selling them what they want to sell, but what the client and/or prospect desires.

With many reasons—representing sales points—for vision care listed, there are yet more. And they also can be used in your sales presentation. A prime example is the fact that eye exams, an integral part of the benefits offering, represent preventive care. Diseases that can be detected in early stages by an eye exam include diabetes, high blood pressure, and glaucoma.

Another fact—and sales point—is that many, if not most, employees spend most of their day before a computer screen. And, because this is so, it’s an equal truism that a qualified eye care professional can furnish much-needed advice and counsel on how to minimize eyestrain and other concerns associated with such exposure.

If what has been mentioned has garnered your interest to the point of further exploring the possibility of adding vision care to your portfolio, then it’s naturally important that you seek out those companies or providers who will best meet your—and your client’s or prospect’s—needs.

Several factors must be ascertained before going forth to market and sell vision care:

• You should check to see if member satisfaction is guaranteed, if the vision plan has consistently delivered, and if there is a substantial referral base of satisfied clients.

• You should also make sure that customer service and administrative support mechanisms are easily accessible and user-friendly, that all marketing materials (brochures, provider directories, discount cards) are professionally prepared and easy to understand… and that commissions are paid accurately and promptly. Speaking of commissions, it should not surprise you to learn that some agents find themselves making more money once they find the right vision plan.

If all checks out, then you’ve found the right vision care plan to offer. And, as hopefully apparent by now, vision isn’t a product to be thrown in your portfolio, only to be taken out when nothing else seems to be working. It’s much too important for that…which you’ll quickly discover should you decide to sell this product to those within a waiting and receptive marketplace.

Paul ]. Disser, a veteran industry marketer, is chairman, CEO, and president of Spectrum Vision Systems Inc., a managed vision care organization and PPO headquartered in Overland Park, Kan., which services over 20,000 companies and four million subscribers throughout the United States, Puerto Rico, and the U.S. Virgin islands. He can be reached by phone at (800) 635-7874 x450, and by fax at (913) 451-1704.

- A Growing Market

- Strong Selling Points

- Choosing a Provider

It’s no secret to savvy insurance agents that vision care is always near the top of the list of benefits most requested by employees, according to the findings of countless surveys. And now, with the addition of laser vision correction (LVC) surgery added to the benefits package on an elective and discount basis, what has been an ever-growing marketplace seems destined to further expand with sales opportunities probably never before envisioned.

There are 150 million Americans who wear glasses or contact lenses. Many of them have availed themselves of various vision care plans which offer eyewear, exams and optical goods on a discount basis. Yet as satisfied as this huge populace seems to be with the products/services provided, a large percentage of them have requested that eye laser surgery be added to the benefits of this popular supplemental product.

What this means to agents is a newfound ability to give clients and prospects exactly what they have long sought. The sale of other insurance products/services will often follow.

Vision often serves as a door opener. It can also serve as a valuable add-on product to the primary product being sold, whether that offering be life or health insurance, disability, dental, long term care or whatever.

An Under-served Market

The current marketing penetration for vision care benefits is relatively low. It’s less than 35 percent in the U.S. labor force, and less than 25 percent among the general population, according to surveys by such organizations as LIMRA, A. Foster Higgins, and Hewitt Associates.

Further, some $3 billion is spent annually on eye examinations, and it is estimated that vision care expenditures will increase 10 to 12 percent annually through the year 2010.

Such impressive facts and figures should encourage agents to consider adding vision care to their portfolio. If they do they’ll quickly discover it is usually a relatively easy sale. Although employees have long been asking for it, most employers have yet to offer vision care as a benefit.

For those who do offer vision care to employers and employees, here are some strong selling points to use:

“Mr./Ms. Prospect, couldn’t help but notice as I opened my proposal that the first thing you did was to put on your glasses for a better look. Did you know that every day, more than 150 million people in the United States, including probably 70 percent of your employees, perform the same function to do their jobs? If I could show you a plan that would help your employees and save them money in the process, would you be interested?”

“Mr./Ms. Prospect, did you know that the majority of adults and many children in this country are in need of glasses or contact lenses? The chances are considerable that many of the adults are your employees. So, you may–and I know your employees would–be interested in a low cost vision care plan that will prove extremely beneficial, and save them a considerable amount of money through discount offerings.”

More Selling Points

Established agents, whether life-health, multi-line or property-casualty, have a natural prospecting base for vision among clients and prospects. As for new agents, vision can prove an effective entry, due to the fact that so few employers offer vision plans.

Another solid selling point is that an eye examination by a qualified professional is good preventive medicine. Some diseases, including glaucoma, high blood pressure and diabetes, can be detected at early stages by an eye exam. Baby boomers now turning 50, many of them suddenly in need of vision care, will substantially increase the percentage of prospective vision care plan members.

A large percentage of employees spend a great part of their workday in front of a computer screen. A qualified eye professional can provide helpful advice to minimize eyestrain and other concerns associated with such exposure.

Ancillary benefits such as vision offered to small and large employer groups provide needed services, while creating new sales and revenue opportunities. Employers are not closing the door to new benefits; rather, they have become much more selective. It is up to the agent to offer the most reliable, appropriate and cost effective product. Doing that, will greatly improve the likelihood of completing a sale and of getting referrals.

Most employers are generally receptive to something that is needed by their employees since it boosts morale and enhances the employer’s image. And, if the offering is low cost, which vision most definitely is, so much the better. This represents good news for the employer and employee.

A Turnkey Plan

Vision care uniquely fits within the preferred provider organization (PPO) concept…meaning, once the sale is made, it’s a complete turnkey plan with no risk, no underwriting and no paperwork for the agent. This is largely attributable to the fact that vision care discount card plans, a major part of the offering, come with no risk transfer or insurance element in the benefit…thus keeping costs extremely low.

How does an agent know which vision plan to offer? The plan selected must meet their client’s/prospect’s unique needs, budget-constraints and administrative objectives. Also, to assure customer satisfaction, simplicity, integrity, quality and economy are required.. .and all are offered by the best vision care plans.

Some vision care plans cost as little as $12 to $18 per year per employee. Variations can be built in which allow for routine eye examinations with optical discounts and designed within the employer’s budgetary considerations; for example, by managing the frequency of the employee’s use of the benefit to once every year or every two years. In addition, it can be managed by scheduling the level of reimbursement for exams, frames and lenses. The cost for such plans ranges from $5 to $12 per month per employee.

Agents should make sure the plan has adequate geographic representation, and ascertain whether it operates nationally, regionally or locally, ..the best plans have been set up so that a vision care plan member is no further than a 20-minute drive from the optical provider.

Other guidelines for agents to follow in selecting a plan include:

- Is member satisfaction guaranteed?

- Has the vision plan consistently delivered what it is supposed to deliver?

- Is there a substantial referral base of satisfied clients?

- Are customer service and administrative easy to understand?

- Are commissions paid accurately and promptly?

If all these factors exist, then you’ve found the right vision care plan to offer to a waiting and receptive marketplace of small to large companies, associations, unions, financial institutions, school districts, municipalities and various other affinity groups.