As employers continue to struggle with the task of guiding employees to healthier lifestyles and a more proactive approach to preventive medicine, they might find some help from an unexpected source: vision benefits.
The reason stems from the fact that employees with vision benefits have eye exams more frequently than a standard health assessment or "physical." Specifically, with an optimally-designed (but not necessarily costly) vision plan, 60% of Americans will see their eye doctor annually, contrasted with 21% of Americans who get annual physicals.[1]
What does that have to do with overall physical health? Plenty.
Eye exams play a crucial role in supporting employees’ overall health because the eyes provide the only non-invasive and clear view of blood vessels without puncturing skin.
Because optometrists can (and do) look at blood vessels during an eye exam, they can help identify symptoms of – and manage – a variety of conditions that might not otherwise be detected at a pre-symptomatic stage.
In particular, an eye doctor can detect signs of more than 30 chronic diseases by seeing changes in blood vessels, as well as representative brain cells in the optic nerve.
By examining the eyes, an optometrist can often detect symptoms of chronic conditions such as hypertension, high cholesterol and diabetes. Indeed, in some cases, an eye exam can lead to the detection of a diabetic condition up to seven years sooner than with standard testing.
‘Enormous’ potential
At most organizations, even if the only health condition detected in the early stages by routine eye exams were diabetes, the potential benefit of that early discovery could be enormous, both for the employee/patients and the employers bearing the financial brunt of the associated medical costs and lost employee productivity.
More than 24 million Americans have diabetes, and an additional 57 million have “pre-diabetes,” according to the Centers for Disease Control and Prevention.
Moreover, those already large numbers are growing, thanks to the evolving obesity epidemic in the U.S. and related lifestyle issues, as well as the aging of the workforce with the maturation of the Baby Boom generation.
Diabetes is the top health problem detected via vision exams. Early detection is critical for a variety of health reasons – not the least of which is that diabetes causes damage to the retina, leading to blindness.
That damage can begin long before any manifestations of diabetes occur that might trigger a glucose test through the employee’s primary care provider. Proactive treatment can prevent blindness.
The good news for some employers is that employee interest in vision benefits may be strong enough that the benefit can be offered – with its intrinsic wellness and health promotion features built in – at a modest cost, or no cost at all, to the employer.
That was the case at BJC HealthCare, a 26,000-employee/40,000 covered lives regional health care provider system based in St. Louis. BJC has 13 hospitals and many more community health facilities in that city and the surrounding regions in Missouri and Illinois.
BJC provided a wellness-oriented vision plan from VSP Vision Care, the country’s largest vision benefit provider, on a voluntary basis in 2010, and 60% of its employees enrolled right off the bat, exceeding BJC’s expectations.
The plan offered employees a stand-alone vision benefit that had not been available previously, according to Kathy Resler, BJC’s vice president of compensation, benefits and HR systems.
Stealth wellness program
But few employees thought of the vision plan as a form of wellness benefit, Resler says. Employees were mostly thinking about the basics – getting a good deal on eyeglasses and contacts -- with the routine comprehensive eye exam just a necessary element of the overall package, Resler explains. (The every-two-weeks paycheck deduction for the benefit ranged from $3 for single coverage, to $10 for a family plan.)
Nevertheless, BJC’s employees gained that built-in wellness benefit, whether they realized it or not, and that’s a good thing. “When you put a wellness plan in place, you’re looking for ways to make it easy for employees to utilize it,” Resler says.
About half of BJC’s employees were already receiving one form of screening or another, but not on a comprehensive basis. With the popularity of BJC’s new voluntary vision plan, the effective level of total health screening is going up, Resler notes.
BJC has begun to review data on the number of employees who, through their eye exams, have been found to have hypertension.
Resler is planning to start adding additional data points (including diabetes detection) to provide an integrated analysis of the vision plan, other "pure" wellness initiatives and basic health plan claims, to fine-tune all health-related benefit plan designs in the months and years ahead.
Stand-alone vision advantage
Meanwhile, massive analysis of the relationship between the type of vision coverage employees have, and their likelihood of receiving a comprehensive vision exam, may assist Resler’s analysis.
Specifically, the study published in July, conducted for the National Association of Vision Care Plans (NAVCP), concluded that people who participate in full-service, stand-alone vision benefit plans are twice as likely to receive an annual comprehensive eye exam, as those whose vision care coverage is bundled with their major medical plan.
The Indianapolis-based NAVCP’s study found that one-third of employees covered by a stand-alone vision benefit received comprehensive eye exams annually, versus a 16% rate for the other group. The study was based on eye exam data for nearly 85 million Americans between 2008 and 2009.
However employees are screened, they -- and employers -- should be aware that diabetics have special eye care needs. Diabetic and pre-diabetic employees may require supplemental medical eye care coverage to ensure that they receive a continuity of care.
In particular, they (including both Type 1 and Type 2 diabetes patients) may require customized diabetic eye exams, diagnostic tests, and digital retinal imaging.
Ideally, these additional services should come from the vision benefits provider without additional charge, to ensure that diabetic employees’ special vision care requirements are met.
Such coverage should allow diabetic patients to receive both their routine and medical eye care from their same eye care provider, saving them time and money.
Such a comprehensive vision benefit plan won’t, by itself, address all of the employee population’s health and wellness needs.
But vision benefit programs that recognize the eye exam’s value as an important medical screening tool can make an important contribution to addressing the difficult challenge employers face in guiding employees to improve their health, at a cost that’s affordable.
[1] VSP Vision Care internal data; Preventive Health Examinations and Preventive Gynecological Examinations in the United States, Mehrotra A. Zaslavsky AM, Ayanian JZ, Archives of Internal Medicine, Vol. 167, No. 17, Sept. 2007, pp. 1876-1883
Author bio: Al Schubert is VSP Vision Care's vice president of Managed Care and Health Policy and a 22-year industry veteran. He can be reached by e-mail at Al.Schubert@vsp.com.
