Pioneer signs pact with NYLCare Ophthalmology services now cover half a million

December 18, 1996|By M. William Salganik | M. William Salganik,SUN STAFF

Pioneer Eye Care, founded by well-known retinal surgeon Bert M. Glaser, announced yesterday a contract with NYLCare Health Plans of the Mid-Atlantic to provide ophthalmology care for its 350,000 members, making Pioneer the largest provider of managed eye care in the region.

Just a year after signing its first managed-care contract, Pioneer now covers eye care for half a million people. Its other major contract is with CIGNA HealthCare Mid-Atlantic, covering 120,000 members, according to Dr. Judith Goldstein, Pioneer's director of clinical services.

Pioneer is one of the most successful of a number of medical groups seeking "carve out" contracts from managed-care organizations, in effect subcontracting for all care in a specific area, such as cardiology. In specialties that are not carved out, managed-care companies contract individually with doctors.

For HMOs and other managed-care insurers, "what Pioneer is, is pTC one-stop shopping," Goldstein said. "It's one entity to contract with. We do all the credentialing, utilization review, claims processing, quality assurance."

Dr. Robert London, senior medical director for NYLCare Mid-Atlantic, based in Greenbelt, said NYLCare was interested in the Pioneer contract because diabetics require retinal screening on a regular basis to avoid serious eye problems that can lead to blindness.

Pioneer, he said, uses new technology to provide "standardized screening and aggressive therapy" for diabetics.

Although Pioneer is willing to contract for screening and treatment for diabetics only -- and does so with CIGNA in Tennessee -- it is seeking contracts to provide a full range of eye services, Goldstein says. Some of its contracts, for example, cover eyeglasses, while others do not.

Its contract network -- in Maryland, the District of Columbia, Virginia, New Jersey and West Virginia -- includes 212 ophthalmologists, 144 optometrists and 19 ambulatory surgical centers.

Pioneer generally receives a flat fee per member per month from managed-care organizations, and reimburses participating eye doctors on a discounted fee-for-service basis, said Marty Brandwin, Pioneer's director of public relations.

Glaser, a former Hopkins professor now based at the Retina Institute of Maryland on the Towson campus of St. Joseph Medical Center, formed Pioneer in 1994, according to Brandwin. Glaser remains its president and principal owner.

Pioneer won its first managed-care contract in December 1995. Located in Towson, it has 17 employees.

Pub Date: 12/18/96

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