Optometry as practiced in health plans within different state jurisdictions

Area of Science:

• Optometry
• Health Services Research
• Managed Care

Background:

• Managed care organizations (MCOs) increasingly influence healthcare delivery.
• Understanding the role and utilization of optometrists within these plans is crucial for effective vision care.
• Optometric practice patterns can vary based on organizational structure and financial incentives.

Purpose of the Study:

• To investigate how managed care plans utilize optometrists for vision and eye care.
• To document diverse optometric practice patterns across different health plans.
• To identify factors influencing the scope of optometric practice within MCOs.

Main Methods:

• A study was conducted across six health plans with varying organizational characteristics, staffing, and payment models.
• A 15-item patient encounter form was used to collect data on patient demographics, clinical activities, and outcomes.
• Data were collected over a four-week period from optometrists at each participating site.

Main Results:

• Optometrists provide a substantial volume and range of vision care services within managed care.
• Observed practice patterns sometimes exceeded or fell short of legal optometric boundaries.
• Organizational factors, financial arrangements, and state licensure laws significantly influenced optometrists' scope of practice and skill utilization.

Conclusions:

• Optometric scope of practice is shaped by a complex interplay of legal, financial, and organizational factors.
• Licensure alone does not solely determine how optometrists' skills are used or delegated.
• Organizational characteristics play a significant role in shaping optometric practice patterns and service delivery within managed care settings.