PATIENT RETENTION

Contact Lens Purchasing Behavior

Understanding why patients walk in your door—and why they sometimes walk out with their prescriptions— is critical to practice success.

Dr. Olivares is director of Professional Education for Vistakon Division of Johnson & Johnson Vision Care, Inc.

By Giovanna E. Olivares, OD, FAAO

Contact lens consumer loyalty is higher than many eyecare practitioners think it is, according to data from a sponsor-masked Internet survey conducted recently by Vistakon Division of Johnson & Johnson Vision Care, Inc. with the help of a third-party market research company. Regardless of where they have their eye exams, only about one in five patients “walks” elsewhere to fill their contact lens prescription. Moreover, lost business isn’t always lost to the Internet—or to the cheapest vendor.

There are essentially four broad “channels” through which consumers may obtain vision care services and/or make vision-related purchases. These include independent eyecare providers not affiliated with a retail brand (IECPs); branded eyecare providers such as LensCrafters and Pearle Vision; branded retailers such as Walmart or Costco, and the Internet (purchases only). While there are a lot of similarities in consumer behavior across these four channels, it turns out that each one seems to attract a slightly different demographic with different expectations and shopping philosophies (see “Channel Selection and Patient Expectations” on p. 37).

Information was gathered in a 60-minute Internet survey conducted in late 2010. All participants were required to have had an eye exam and made a vision correction purchase in the previous 18 months. A total of 7,685 vision-corrected adults, ages 21 to 60, completed the survey about where they received their vision care, where they purchased contact lenses and spectacles, and their expectations and motivations in making vision care purchase decisions. The survey population included 2,579 contact lens wearers, widely distributed across different brands.

How Patients Choose a Channel

What prompts patients to choose one location over another for their eye exam? Between 2007 and 2010, vision insurance coverage gained in importance, becoming a leading reason for selecting one channel or provider over another. Patients also weigh convenience, price, office environment, and other factors, depending on their own shopping philosophy. Most people surveyed say they chose a location “where they had always gone” or where a trusted source recommended that they go. Relatively few (<10 percent in most cases) actually researched credentials or prices before making an appointment. Rather, they tend to rely on assumptions about what each of these channels offers them.

IECPs perform the most eye exams by far—55 percent of the total compared to 18 percent each at branded eyecare providers and branded retailers (the other 9 percent were unsure or didn’t fit into a clear category, Figure 1). And that’s a good thing for practitioners in independent practice, says practice management consultant Scot Morris, OD, FAAO. “It all starts with the professional services. If you get them in the door for an eye exam, then you also have a shot at selling them products,” he says.

The research shows that most patients (73 percent) purchased glasses or contact lenses at the same time and in the same location as their eye exam. Some made no purchases or later purchases, but only about 20 percent filled a prescription somewhere other than where they’d had their exam. There was no difference in the rate of “walks” across all of the channels.

Figure 1. 2010 Core Channel Contact Lens Buying Dynamics Summary.

The top consideration in where to purchase contact lenses is acceptance of the consumers’ insurance, ranked as “extremely important” or “very important” by 56 percent of consumers. More than 40 percent of respondents also cited state-of-the-art equipment, a reputation for quality, the ability to take care of all of their vision needs, having an optometrist on site, a wide selection of contact lenses, and low prices on contact lenses as extremely/very important factors in their purchase location decision. Advertisements, special sales, and location were cited as extremely/very important factors by less than 30 percent of respondents.

The good news is that contact lens patients are very loyal shoppers, with 89 percent of those who bought lenses at branded retailers, 82 percent of those who bought at IECPs, and 73 percent of those who bought at optical chains saying that they planned to buy from the same location the next time (Figure 1). Even higher percentages (e.g., 93 percent of those who had an exam at an IECP) intend to return to the same location for their next exam.

Who Walks and Why

Compared to earlier surveys conducted by Vistakon, “Rx walking” appears to have increased slightly for all channels—but most significantly for branded retailers. The increase in walks from IECPs was not statistically significant. Although the Internet continues to represent the primary beneficiary of Rx walking, the online channel’s share has declined significantly. In 2007, 68 percent of those who walked from an IECP and 100 percent of those who walked from a branded retailer bought online. By 2010, only about half (52 percent to 55 percent) of those who walked from any eye exam channel purchased online.

The survey dispels several other myths about who is most likely to walk. For example, there were no significant differences by brand, meaning that wearers of Acuvue (Vistakon) and other popular and widely available brands are no more or less likely to go to another channel to make their purchases. Replacement frequency was also not a factor. Two-week lens wearers, who would be expected to need more boxes of lenses throughout the year, were no more likely to purchase at a different location than were patients wearing monthly lenses (Figure 2).

Although cost was the leading reason that respondents cited for buying lenses somewhere else, other reasons commonly cited had little to do with cost, including office hours/location (33 percent); customer service (27 percent); and ease of ordering (20 percent). Patients who took their prescription to a Costco location were most likely to be motivated by perceived lower prices, while those who walked to a LensCrafters were more likely to be motivated by the practice environment and level of customer service. Internet purchasers were just as likely to be drawn to the convenience of being able to order their contact lenses at 2:00 a.m. as they were to perceived lower prices.

The perception that online prices are lower is often inaccurate, says Dr. Morris, who urges eyecare practitioners to not shy away from talking about prices with their patients. He and the staff in his private practice in Denver, Colo., have created a spreadsheet of the total, per-box, and per-day cost for every brand of contact lenses that they prescribe, factoring in manufacturer rebates, annual supply discounts, and insurance. When a patient does raise concerns about contact lens prices, he can show them the true value of purchasing from him.

Figure 2. Purchases at same location as exam (by replacement frequency).

“Once you factor in the shipping and handling that online retailers charge and the discounts we’re able to offer for an annual supply, we are usually very competitive,” he says. Another big advantage for IECPs and retail channels is the ability to fix problems such as replacing torn lenses or exchanging unopened boxes in the event of a prescription change. “Patients immediately see the value in that level of service compared to a faceless, one-time transaction. But if you don’t talk about the value, they have nothing to compare except that price-per-box number,” says Dr. Morris.

Another common situation he sees is that patients will mention that friends or family members pay a lot less for their lenses online. “Often there is a clinical difference that I can point to. For example, I might say, ‘Mrs. Jones, your brother is wearing an older-technology lens and he’s probably struggling with comfort at the end of the day. We’ve got you in the most comfortable multifocal contact lenses available, and that means that no matter where you buy your lenses, you’ll probably be paying a little more than he will.’”

Retain Patients—and Their Purchases

Retention is so critical to practice success. Just imagine the growth your practice could enjoy simply by retaining 10 percent more of your existing patients each year, while at the same time increasing referrals and adding more new patients. To some degree, the ability to retain patients and keep their contact lens purchases in-house depends on how well you meet the expectations for your setting. An IECP’s primary competitors, for example, are largely other private practices and, to a lesser degree, optical chains rather than branded retailers.

“You absolutely need to invest some time and money into getting to know both the demographics of the community where you practice and the demographics and expectations of the segment of that population that is attracted to your practice,” says Dr. Morris. Such information can be obtained from websites such as www.zipskinny.com, your local chamber of commerce, “secret shopping” other practices, and from surveying your own patients, he says.

A small but key finding in the vision care patient survey was that contact lens patients said that their practitioners discussed lens changes with them only about 25 percent of the time. However, product excellence, practitioner knowledge and reputation for quality, and availability of the latest technology are among the qualities that patients—especially those who choose IECPs—value most.

Michael A. Slusky, OD, who is in a Vision Source practice in Chicago with his wife, starts every exam with returning patients by thanking them for coming back. And then he asks a question designed to connect his professional services directly to the medical devices he prescribes: “Is there anything about the lenses I prescribed for you last year that you wish was better?” he asks. “The response to that question often provides me with the clinical rationale for upgrading them to a new lens, as well as the chance to immediately solve a problem that matters to them.”

As someone who has worked in a variety of vision services channels during his career, Dr. Slusky says retention is really all about your relationship with patients, regardless of the setting. “A patient can be seen in a private practice or in a commercial or independent-affiliated-with-a-retailer setting and have a satisfactory experience. But that is not what builds loyalty,” he says. “Patients who don’t have an existing relationship with a practitioner might go to a retail setting because of the name recognition, but that’s not enough to make them stay. Wherever you practice, you have to offer good value for their money and build a relationship of trust. It’s really up to practitioners to provide the care and service that will generate loyalty and guarantee a return visit the next time patients need to make a vision care purchase.”

The Value of a Contact Lens Wearer

On average, contact lens wearers purchase an eight-month supply of lenses, but 43 percent say that they are open to buying a larger supply. Their exams are prompted primarily by the need to replenish their supply of lenses, with seven out of 10 saying that they needed an exam to get a new prescription; only a minority were prompted by a change in vision or other eye problems. Contact lens wearers make purchases five times more frequently than spectacle-only wearers do.

“Some practitioners may think of spectacles as the primary source of profitability for their practice and overlook the opportunities with contact lenses,” says Dr. Slusky. “Contact lens wearers are really the gateway to all arenas of the optical business, including medical care,” he says. Contact lens patients return every 12 to 18 months, while the average return rate for those who only wear glasses is 26 to 28 months.

“There is no question that the greater the number of touchpoints you have with your patients, the more of an opportunity you have to inspire loyalty and grow the practice,” says Dr. Slusky. “You have more chances to build a relationship that goes beyond providing glasses or contact lenses to taking care of their kids or parents and treating their dry eye, allergies, or glaucoma and other ocular conditions.”

In addition to returning for exams more frequently, contact lens patients pay higher professional service fees and are more likely to make dual purchases by adding on backup glasses or non-prescription sunglasses, he finds. According to the survey, lens wearers are also slightly less likely than spectacle wearers are to walk with their prescriptions.

The Take-Away Message

The biggest piece of good news to come out of this survey is that fewer patients “walk” than we think. When patients do decide to take their prescription elsewhere, price may be just one of several factors that you can influence by clarifying the value of your products and services and meeting (or exceeding) patient expectations of their exam and purchase experience. To do that, you need to understand who your patient population is, why they chose to walk in your door, and what they want when they get there. CLS

Dr. Morris is a consultant to Marco and a paid speaker for a number of companies, including Allergan and Johnson & Johnson Vision Care, Inc. Dr. Slusky is a consultant to Alcon and Johnson & Johnson Vision Care, Inc. and is on the faculty at The Vision Care Institute, LLC.