Byline: Susan Egbert and Richard Stolz
Routine eye care facilitated by employee exploitation ofvision care benefits can be a vital adjunct to standard employee health promotion efforts, helping to detect and address serious clinical conditions beyond those pertaining exclusively to eye care, recent research shows.
The new data, which covers both clinical issues and their financial implications for employers, adds a new twist to the existing robust body of evidence of the adverse economic impact of vision-related health conditions. It points to the importance of careful design of vision benefit plans, as well as the effective promotion of such plans to employees so that both health and financial benefits can be gained by employees and employers alike.
The study, performed by Human Capital Management Services, a Wyoming-based data analytics and consulting firm, and commissioned by VSP Vision Care, focused on the detection of diabetes, hypertension and high cholesterol by optometrists before those conditions were identified by other health care providers, particularly patients' primary care physicians.
Given the fact that many employees and their dependents have these conditions without being aware of it in their initial stages, the more health care professionals (whatever their medical specialty) who have an opportunity to detect them, the better. For example, nearly one-fourth of the 24 million Americans believed to have diabetes are oblivious to that fact, according to the Centers for Disease Control and Prevention. From an eye disease perspective, diabetes causes a condition known as diabetic retinopathy, damaging the retina leading to vision impairment if left untreated.
wSimilarly, hypertension and high cholesterol, with their potentially deadly consequences, are often unknown to those who have the conditions. Optometrists routinely detect them, according to optometrist Dr. Michael Johnson, of Eagle Vision Eye Care in Sacramento, Calif.
Proper eye exams, he says, include examination of blood vessels of the eye. 'Diabetes,' he says, 'would most easily be seen by bleeding in the back of the eye.
'For early onset, we'd see small 'dot hemorrhages' - just a little pinpoint of blood. Where it's located in the eye would determine the level of referral that is needed. If you see it just in the periphery of the eye, that would be something we'd watch. As it gets closer to the macula, that would require referral.'
Hypertension, he adds, is evident to an optometrist through detection of 'tortuosity of the blood vessel - it looks like a kinked hose,' he says. 'We also look for how the blood vessels cross each other;' certain patterns can reflect the damaging impact of high blood pressure. (Eye exams may also be accompanied by standard blood pressure checks, Dr. Johnson notes.)
And optometrists can see evidence of high cholesterol levels, according to Dr. Johnson, 'because people with high cholesterol throw off plaque from their carotid artery, and often it will get stuck in the bifurcations, or forks, of the blood vessels in the back of the eye. We'll see a bright refractile material stuck in that bifurcation.' Doctors may also see a grayish-white ring around the cornea called arcus senillis or corneal arcus.
The potential of eye exams to flag fundamental health problems is perhaps even more compelling when viewed in the broader context of workforce demographic trends and their implications for employees' eye care needs. The aging of the baby boomer generation, for example, is expected to lead to a doubling of the number of people experiencing vision-related problems, with consequences not only for their health, but boomers' productivity at the workplace. And, because the eyes are the only place on the body through which blood vessels can be viewed, the opportunity to identify other health issues is further perpetuated.
Visual stress
And simple 'visual stress,' according to the American Optometric Association, 'is a common occurrence in today's visually demanding world' - and not just for older workers. Manifestations of 'visual stress' include regular headaches, diminished focusing power, intermittent blurring and loss of concentration, according to the AOA.
The negative business and personal impacts of these problems have, of course, encouraged most midsized and large employers to make vision benefits available to their employees. A study by Prevent Blindness America, for example, estimated the national annual price tag for adult vision problems at $51.4 billion. That 2007 study included the impact of diabetic retinopathy, the condition optometrists often identify to alert patients to its broader health implications.
Eye doctors' clinical skills that allow them to identify health issues such as diabetes, hypertension and high cholesterol is one matter. But ensuring that patients connect with their primary care physicians to address these conditions, of course, is critical to having a positive outcome. Sophisticated imaging equipment can play a useful role towards that end, according to Dr. Johnson.
'The nice thing about having the kind of equipment I have,' he says, 'is that I can show patients what I'm seeing, like blood in their back of their eye. It makes it more real to them.'
It is the responsibility of patients to take appropriate steps with the primary care provider to address the medical issue identified in the eye exam. But Dr. Johnson says that if he has any concerns about what will happen after the patient leaves his office, he will contact that patient's primary care physician. Relaying clinical information to other health care providers is facilitated, he says, by automation.
'We use a system that makes it very easy to communicate' essential clinical information both to patients and other health care professionals. 'We can print it out and give it to the patient and fax it to the primary care doctor, and know that they're getting all the information they need to move forward.'
The benefits of this kind of communication, according to the HCMS study, can be substantial - especially considering the high human and economic cost of diabetes, hypertension and diabetes. The study, using a HIPAA-compliant process, compared clinical and financial claims data of patients with VSP coverage, to a broader patient universe.
VSP Eye Health Management Program
In 2005, VSP launched a program called the VSP Eye Health Management Program, which requires the eye care professionals in its provider network to report patients with early signs of diabetes, diabetic retinopathy, hypertension, corneal arcus (a symptom of high cholesterol), macular degeneration and glaucoma.
The study concluded that, of all early detections, these optometrists identified 20% of diabetes cases, 30% of hypertension cases and 65% of high cholesterol cases, before they were identified by patients' other care providers, and before the employee self-reported the condition in a personal health assessment survey. A potentially key factor in this result is the fact that workers with vision benefits receive eye exams more frequently than they receive annual preventive exams. Specifically, only 21% of adults receive an annual preventive health exam, but 61% of Americans with vision coverage receive annual eye exams, according to a study reported in the Annals of Internal Medicine.
Impacts of early detection of these health conditions by the eye exams, according to the HCMS study, include the following:
* Health care and pharmacy costs and comorbid conditions were significantly lower in the early detection group, perhaps because later care and treatment typically is more costly.
* Lost-time costs for short-term disability, long-term disability and workers' comp generally were lower for the early detection group.
* Early detection group members were half as likely to terminate their employment during the year following detection of the heath issue. One possible cause of this result may be later detection of health condition leading to increased comorbidity and more extensive treatments, ultimately leading to loss of employment.
Pennies on the dollar
HCMS analysts estimated the purely economic benefits (measuring medical costs, lost time and human capital costs) of providing this type of vision benefits equate to 94 cents of additional value for every dollar spent on vision exams. The biggest savings, according to the study, resulted from the early detection of diabetes.
The overall savings figure suggests that the net cost of every employer dollar invested in a vision benefit - assuming the eye care professionals participating in the plan provide comprehensive eye exams and report relevant findings to primary care providers, along the lines of the VSP program - might be as low as 6 cents.
But employees must take advantage of vision benefits in order for them and their employers to reap the potential health and financial rewards.
While employees with common vision impairments, such as myopia,typically don't need to be encouraged to take advantage of a vision benefit plan, others often do; ignorance on eye health is widespread. For example, a 2006 survey by the National Eye Institute revealed that only 8% of respondents were aware that glaucoma has no early warning signs.
Such data suggests that many employees who don't perceive that they have a need for eye care might fail to appreciate the importance of routine examinations.
The following approaches can significantly increase employee participation in vision benefit programs:
* Provide employee workshops. Use vision plan materials to educate employees on the importance and value of vision care for themselves and their dependents. Use available materials to host a brown-bag or workshop session on the vision benefit.
* Partner with your representative. If possible, bring in a vision plan representative to discuss the value of their benefit with the employees and answer their questions about coverage.
* Remind employees that these benefits are pretax. This reminder increases savings over vision exams and materials purchased without a plan.
Maximum employee participation in vision benefit plans, coupled with a system enabling eye care professionals to communicate easily and effectively with plan members and their primary care providers when conditions such as diabetes, hypertension and high cholesterol are evident, can ensure a high return on employers' investment in vision benefits.
Susan Egbert has over 20 years of health care experience and is director of utilization and quality management at VSP Vision Care, based in Rancho Cordova, Calif. Richard F. Stolz, a former editor and publisher of Employee Benefit News, is a freelance writer based in Rockville, Md.
