Employer Opportunities for Value & Potential Cost Savings
1. Ask your health plan about its network of doctors of optometry
Doctors of optometry can serve as the primary care provider for eye health. Optometrists provide less expensive, conservative care while ophthalmologists usually start with more expensive surgical treatments. When appropriate care is delivered through the right provider, cost savings are realized.
Eyes reveal more than just vision issues and can detect diseases such as diabetes, hypertension and cancer. Eyes are also the only place where a doctor can view the health of the brain, nerves, blood vessels and connecting tissue without cutting into or scanning (X-ray, CT scan, MRI) a body part.
Comprehensive Eye Exams can detect:
- Brain tumors
- Signs of stroke
- Medication toxicities,
- Vision conditions such as glaucoma, cataracts and macular degeneration
It is estimated that 99% of the U.S. population lives in a county with an optometrist.
Doctors of optometry can:
- Diagnose and treat eye injuries, emergencies, infections, inflammation and allergies
- Diagnose and treat ocular diseases such as glaucoma
- Prescribe or provide oral and topical medications, therapy, corrective lenses and optical devices
- Perform procedures, both minor and surgical
A recent study commissioned by AOA demonstrates that significantly higher costs result from inappropriate use of Emergency Room (ER) facilities and Primary Care Physician (PCP) offices by patients seeking medical treatment for eye problems.
A Florida-based study looking at eye care related emergency room visits identified 108,786 non-emergency cases that could have been treated effectively by a doctor of optometry.
- These emergency room visits generated more than $120 million in costs ($1,105 per case).
- Emergency rooms are often used when doctor’s offices are closed, although doctors of optometry are generally open evenings and weekends
- The study revealed that by diverting eye care services from the emergency room or primary care settings to doctors of optometry, patients achieved improved clinical outcomes and showed a potential cost savings of $0.18 Per Member Per Month (PMPM).
- These studies indicate that there are PMPM cost savings that could be directly attributable to an employer’s medical benefit by incorporate a robust network of doctors of optometry into an employer’s physician network. Adding integrated benefits strategies could yield even stronger clinical outcomes and cost savings.
Source: Florida Medicaid Could Achieve Savings of More than $70 Million Annually. Healthcare Management Decisions Inc.
2. Use an integrated benefit providing eye health coverage focused on comprehensive eye exams
National experts agree that the only way to ensure healthy eyes is through an annual comprehensive eye exam which plays a vital role in detecting vision issues and common eye conditions. These exams are also important in early detection and ongoing management of some costly chronic conditions and can impact absenteeism and productivity. By providing a streamlined and integrated benefits strategy for eye health and vision benefits, employers can:
- Reduce overall risk score of covered population
- Eliminate confusion and inform employees about benefit plan coverage
- Educate employees about the importance of regular comprehensive eye exams to protect eye health and to detect and help manage chronic conditions
- Emphasize a company’s commitment to preventive and health improvement benefits in the plan design
- Gain more effective data and care coordination when planning for long-term costs
It’s important for employers to ask benefit advisors and carriers to include eye health in their offerings.
Key elements of a comprehensive eye and vision exam
Many eye and vision disorders have no obvious symptoms, so individuals are often unaware that a problem exists. Early detection of a disease or condition allows your employee to take preventive measures, start treatment sooner when it may be more effective, and decrease the risk of vision impairment and permanent damage to sight.
In addition to the patient’s history, key elements of a comprehensive eye exam include:
- Eye Structure Examination – Assessment of all structures of the eye, internally and externally, that may affect vision; evaluation of general health, diseases (including neurological issues and systemic conditions) and vision conditions
- Preliminary Tests – evaluates depth perception, color vision, eye muscle movements, peripheral or side vision and the way pupils respond to light
- Visual Acuity Measurement – Evaluates how clearly each eye is seeing using the “eye test” that involves reading letters or symbols on charts at near and far distances
- Refraction – Determines the lens power needed to compensate for any refractive error, such as nearsightedness, farsightedness or astigmatism. This test determines the prescription strength and is what most people associate with an eye doctor
- Keratometry – Measures the curvature of the cornea (clear outer surface of the eye) by focusing a circle of light on the cornea and measuring its reflection; this test is critical in determining the proper fit for contact lenses
- Eye Focusing, Eye Teaming and Eye Movement Testing – An assessment to determine how well the eyes focus, move and work together
- Eye Health Evaluation/Supplemental Testing – Additional tests that may be required to rule out possible problems, clarify uncertain findings or provide a more in-depth assessment.
- Glaucoma test (age based)
3. Design a value-based benefit that promotes eye health
Integrated benefits that provide eye health coverage focused on preventive comprehensive eye exams, paired with coverage and/or discount programs to support prescription eyewear, is an effective strategy for providing an enhanced benefit while saving the employee and the company money.
Examples of essential coverage options include:
- Yearly comprehensive eye exams covered with no cost sharing under the medical benefit (one comprehensive eye exam on an annual basis)
- Coverage and medical policies that are aligned with evidence-based clinical practice guidelines
- Corrective lens and eye glass coverage options:
- Provide an allowance for prescription eye glasses or contact lenses (i.e. $100 annually, or more) to assist with out-of-pocket costs associated with vision care
- Contribute to a Health Savings Account (HSA) that employees can use at their discretion for eye exams and prescription lenses – this can encourage employees to use their benefits by covering routine comprehensive care and allowing individual choices on treatment purchases
- Contribute to a Health Savings Account (HSA) or Flexible Spending Account (FSA) that employees can use at their discretion for eye exams and prescription lenses – this can encourage employees to use their benefits by covering routine comprehensive care and allowing individual choices on treatment purchases
- Provide access to a voluntary eyewear benefit plan
4. Create a benefits package that incorporate eye care into the medical plan
Employer stories coming soon