Vision Insurers Eye Employers’ Interest in Wellness

Vision providers are piggybacking on employers’ heightened interest in wellness, making the case that cost-cutting efforts shouldn’t jeopardize the potential for using eye exams to help detect high blood pressure and other medical conditions that might otherwise go undiagnosed.

It’s an argument they are making against a backdrop of several, to some extent, conflicting trends.

On one hand, the Patient Protection and Affordable Care Act is expected to improve preventive care, which likely will boost access to vision specialists, says Maureen West, a director at the American Optometric Association. But in a tight economy, all benefits are subject to scrutiny—and cutbacks in eye care are inevitable, according to data and vision coverage experts.

In the past two years, 7.3 million U.S. adults have lost their vision insurance, with 110.6 million Americans reporting coverage in 2010 compared with 117.9 million in 2008, accrding to a survey by the Alexandria, Virginia-based Vision Council, a trade group for optical manufacturers and suppliers. Jeff Spahr, staff vice president of vision and voluntary services for the Indianapolis-based health insurer WellPoint Inc., also notes increased price sensitivity among employers.

Vision, because of its low cost compared with other medical coverage, tends to be one of the last places employers look to trim health benefits, Spahr says.

“But relative to prior years, the conversation and questions around cost are coming up more and more often,” Spahr says. “In particular with larger employers, I’ve seen a tendency to actually shop vision where they previously had not.”

Meanwhile, vision providers are striving to reframe the discussion, pointing out that for a low upfront investment, regular eye care can pay off significantly, particularly given the vision and other medical needs of an aging workforce. VSP Vision Care, the Rancho Cordova, California-based vision benefits provider, with 55 million members, says the average age of its participants is 44.

Vision problems can rack up a hefty price tag in direct and indirect costs, including productivity, totaling $35.4 billion annually, according to a 2006 Archives of Ophthalmology study cited by West as one of the most comprehensive. But the eye, with its latticework of blood vessels so easily visible during an exam, also can provide an early glimpse into other chronic conditions, including diabetes and high blood pressure, West says.

“We are really in a prime spot for detecting systemic disease,” she says, calling eye care “another primary-care touch point. Many people don’t go to a primary-care doctor at all. But a vision issue will often prompt them to pick up the phone and make an appointment.”

Beyond 20:20
The good news is that despite an aging population, computers and other eye-straining trends, vision benefits costs are projected to increase slightly less than last year, according to the 2011 Segal Health Plan Cost Trend Survey. This year, costs for vision insurance is projected to increase no more than 3.5 percent compared with a projected ceiling of 4.1 percent for 2010. And those increases, albeit higher than inflation, are dwarfed by 2011 cost projections that range as high as 12 percent for medical insurance, according to an analysis conducted by the Segal Co., a benefits and human resources firm based in New York.

Vision benefits typically run an employer about $60 annually for family coverage, says Lawrence Singer, a Segal senior vice president and expert on voluntary benefits. “Optical care is not as age-sensitive as medical care,” he says.

“While an individual might need multiple procedures some years as they get older, they likely won’t need more than one new pair of lenses annually,” he adds.

Cost projections also have been held down by the relative affordability of eye materials and related services, Singer says.

For their part, eye-care providers are talking up their workforce role beyond a new pair of progressive lenses. Vision difficulties can erode productivity in ways that employers and employees may not realize, says Melody Healy, VSP’s director of product, strategy and integration. Aches and pains? The real culprit could be computer-related eye strain.

But employees “don’t correlate it to eye strain because the pain is in the neck, back or shoulders,” she says.

Employers also shouldn’t leave the eyes behind, as they move more aggressively into disease management, says West, who directs the association’s Third Party Center, which advocates for eye coverage to insurance providers.

When West speaks with business groups about managing diabetes, for example, “many say that eye care and foot care are the sleepers. I think so many companies focus on prescription drug maintenance they lose sight of the other aspects of care that are really important.”

In 2009, just half of people with diabetes received an annual eye exam, according to federal data reported to the National Business Coalition on Health. More than 80 percent got an annual A1c test, to assess average blood sugar levels, and cholesterol screening.

Trimming vision costs
   Price-sensitive employers have some alternatives to dropping vision benefits completely, such as asking employees to subsidize part of the cost, says WellPoint’s Spahr.

In a 2010 survey conducted by WellPoint, 88 percent of U.S. adults said access to a wide variety of benefits was important in their decision whether to accept a job, even if some of them required the employee to foot a portion of the total cost. According to the same survey, which involved 2,500 adults, 55 percent reported sharing the cost for vision coverage with their employers compared with 59 percent for dental and 67 percent for major medical.

In the last couple of years, there has been a shift toward employers not providing any vision subsidy, particularly among new VSP clients, according to Healy. She declined to release any related data, saying that they were proprietary.

Another cost-trimming option, which Healy supports, is for employers to continue to pay for a regular eye exam, while giving the employee the voluntary option regarding lenses and other vision materials.

“Don’t go short on the eye exam,” she advises employers, “because the eye exam is what will get your people into the health care system.”

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