Medicare Exploration Project
VisionServe Alliance Launches Phase II of this Vital Industry Initiative
The Medicare Exploration Project addresses these three critical challenges related to vision rehabilitation services:
- Inadequate funding, which is primarily limited to those funds from the Rehabilitation Services Administration “Older Individuals Who Are Blind” (OIB) program,
- A shortage of trained vision rehabilitation professionals, and
- Logistical difficulties associated with delivering in-home services to Older Adults outside the traditional healthcare system
Responding to these challenges, this project seeks to enhance the accessibility and availability of vision rehabilitation services by pursuing two key strategies. First, to increase the sources and amount of funding for these services. Second, to expand the pool of professionals providing vision rehabilitation services. At the conclusion of Phase I, VisionServe Alliance identified several effective approaches to achieve these goals during Phase II of this vital industry project:
- Evidence-Based Vision Rehabilitation Services Research
- Agency Training on Medicare Advantage, Medicaid, and Community Care Hub Reimbursements (provided by VisionServe Alliance)
- Occupational Therapy Integration – a Hub-and-Spoke Approach
Phase II of the Medicare Exploration Project consists of these three parts:
Evidence-Based Vision Rehabilitation Services Research
The Medicare Exploration Project will commission a comprehensive review of evidence-based research that communicates the effectiveness of vision rehabilitation services. By demonstrating effectiveness, the Medicare Exploration Project arms advocacy and service leaders with compelling evidence to pair with the Big Data Project Reports. This combination of evidence-based research on the prevalence of people living with vision loss and the proof that vision rehabilitation is an effective service that helps them live independently will be crucial when approaching the payers mentioned below. A well-respected and accomplished epidemiologist, Dr. April Zambelli-Weiner, and TTi Health will conduct this review (see short bio below).
The study will synthesize existing research to measure the tangible benefits of vision rehabilitation services, culminating in a report that we anticipate will confirm the positive impact of these services on the independence of older Americans experiencing vision loss. This evidence-based report will illustrate how vision rehabilitation fosters independence and significantly reduces healthcare costs for older Americans. This study will strengthen advocacy for increased funding from Medicare Advantage and Medicaid programs when used with the Big Data Project reports.
Diversifying Funding Streams
To secure sustainable funding, the Medicare Exploration Project explores multiple avenues, such as:
- Occupational Therapists services that can be billed through traditional Medicare and Medicaid (insurance-based services)
- Non-traditional healthcare system billing, including Medicare Advantage Programs, Medicaid Waiver Programs, and Community Care Hubs
These systems can be approached to secure reimbursement for vision rehabilitation services from Occupational Therapists and Vision Impairment Specialists (CLVT, CVRT, and COMS).
Education Series – Agency Training on Reimbursements
VisionServe Alliance will create eight 90-minute training sessions to equip our members with the knowledge and strategies necessary to engage with regional Medicare Advantage providers, Medicaid offices, Independent Living Centers, and Community Care Hubs. Training will highlight the service delivery process for populations experiencing the adverse effects of social determinants of health and health inequity. Our Big Data Project reports confirm that millions of people living with vision loss meet this criterion and qualify for services through this delivery system. To create this series of eight 90-minute classes, we will partner with Sharon Williams-Jaxson Consulting, an expert in supporting community-based organizations, government agencies, and health organizations serving Medicare and Medicaid consumers (see short bio below).
Incorporating Occupational Therapists (OTs)
MEP proposes enhanced integration of Occupational Therapists into the vision rehabilitation service delivery system, vastly increasing the number of practitioners providing vision rehabilitation services to expand and enhance nationwide service delivery.
Using a hub-and-spoke model, Occupational Therapists will be identified in agency catchment areas where the population is more challenging to serve. Each agency will create a database of OT’s and act as the hub. Then, targeted training is provided to ensure that OTs (the spokes) understand all vision rehabilitation service modalities. As OTs are identified and trained, they are entered into an agency’s vision rehabilitation professionals’ database for dispatch on a per diem basis. This model integrates OTs into the service delivery framework, enabling efficient reach and support to seniors in their homes while simultaneously containing agency personnel costs.
A comprehensive training program ensures the agency’s administrative and clinical occupational therapy staff can effectively manage and deliver vision rehabilitation services offered by per-diem OTs. Since OT-provided services are eligible for Medicare reimbursement, agencies will also be trained on Medicare billing to maximize revenue.
Up to twelve VisionServe Alliance agency members will participate in the pilot program training. We will thoroughly evaluate interested members, assessing their current scope of services, staffing, and medical billing infrastructure. Two for-profit healthcare agencies have successfully implemented this innovative service model. In addition to increased service capacity and revenue (through Medicare and other incremental service billing), this model fosters greater in-home vision rehabilitation service delivery and enhanced well-being for the vast number of seniors living with vision loss who cannot currently access these life-changing services.
Join Us!
Please join us by pledging a gift today! Contact Lee Nasehi at Leen@VisionServeAlliance.org or 407.301.5193.
Our Phase II Expert Project Consultants:
Sharon Williams-Jaxon, Founder and CEO, Williams Jaxon Consulting
Sharon is at the forefront of providing specialized expertise to organizations and government agencies serving Medicare and Medicaid consumers. With a results-driven approach, Sharon supports the delivery of high-quality, culturally competent, integrated, and cost-effective healthcare solutions. Sharon has served as the CEO of CareSource Michigan, a top-ranked health plan, and as COO for a nationally recognized Area Agency on Aging. Her strategic leadership has been instrumental in directing key functions such as business development, legislative affairs, marketing, compliance, public policy, community engagement, and government relations. Sharon’s affiliations with leading industry organizations include America’s Health Insurance Plans (AHIP), Medicaid Health Plans of America (MHPA), and Association for Community Affiliated Plans (ACAP).
Dr. April Zambelli-Weiner and TTi Health
Dr. April Zambelli-Weiner is renowned for her extensive expertise in epidemiology and her dedication to enhancing health policy and practice through data-driven evidence. As the Founder and CEO of TTi Health Research and Economics, she is instrumental in bridging the gap between healthcare research, technology implementation, and healthcare services delivery, to ensure that innovative medical technologies and services reach the market quickly and effectively. Dr. April Zambelli-Weiner sits on the Healthcare Information Management Services Society (HIMSS) Public Policy Committee to advance global policy and policy positions on legislation and regulations. Her unique depth of knowledge in public policy, workforce development, research, and analytics aids her collaboration with government officials worldwide. Working with government agencies, such as the CDC, she has overseen and advanced health policy models and has been at the forefront of national health initiatives, contributing to the market introduction and growth of numerous medical technology products and services. She holds a Ph.D. in Human Genetics and Epidemiology from Johns Hopkins University, an MPH in Epidemiology from Saint Louis University, and a BA in Chemistry and English from Washington and Jefferson College.
