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Employers incorporate vision benefits into wellness programs

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Vision benefits are becoming more than just a low-cost perk. Some health plans and employers are folding vision coverage into wellness and disease management programs to tame the cost of treating chronic disease.

"I do believe managed care companies have embraced the preventative nature of a comprehensive (eye) examination and how that can save them money," said Joseph Carlomusto, president of Davis Vision Inc. in Plainview, N.Y., a subsidiary of health insurer Highmark Inc. His company urges health plan clients, at a minimum, to cover eye exams in their basic coverage.

Everyone can benefit, he said, because "the eyes are the window to the entire body."

Louisville, Ky.-based Humana Inc. announced plans last month to acquire CompBenefits, which provides dental and vision benefits plans to more than 4.8 million members. Vision "is one of those benefits that fits real well into the overall health package," said Mark Matzke, chief operating officer for HumanaDental in De Pere, Wis. Humana will use its disease management programs to encourage high-risk patients to see an optometrist, he said.

Employers are catching on as well. "Several of my employers in the last several years have adopted a very rich vision wellness component by encouraging annual eye exams for everyone--and then trying to promote that," noted Carl Mowery, managing director of compensation and benefits at SMART Business Advisory & Consulting L.L.C. in Chicago.

One of Mr. Mowery's clients, a large pre-K-12 school district, knew of studies linking children's vision problems to poor performance in the classroom. School officials encouraged parents to have their kids' eyes checked, but the district had no vision benefit of its own until three years ago. "There's just so much research and evidence that vision exams can reveal diseases like diabetes and high blood pressure," said Beth Berg, benefits coordinators for Illinois School District U-46 in Elgin, Ill. It "just made sense to go ahead and offer that," she said.

Spectera, a unit of UnitedHealth Group Inc., has launched programs with a couple of key customers to share vision exam data with employees' health plans. The goal is get people who have indicators of disease to seek further testing and treatment, said Jim Fuhrman, executive vp of sales at Spectera UnitedHealthcare Dental in Agoura Hills, Calif. He said the company is looking to expand the data-exchange with all of its customers.

Purchasers and payers are acting on a growing body of empirical evidence demonstrating a link between eye problems and chronic disease. Studies show that elevated blood pressure, for example, can cause a blockage of the arteries and veins supplying blood to the retina. Hypertension is also a risk factor for age-related macular degeneration, a condition that results in the loss of sharp central vision.

Vision testing is also critical for people with diabetes, said Dr. Larry C. Deeb, president of medicine and science for the American Diabetes Assn. and medical director for the diabetes center at Tallahassee Memorial Hospital. Diabetics are prone to retinopathy, a progressive eye disease that can lead to blindness.

"You can help motivate a patient pretty profoundly to control his or her diabetes better if he goes to the eye doctor and (the doctor) says, 'You know, I see some early changes in the back of your eye. You really need to control your diabetes better...so it doesn't progress,"' Dr. Deeb said. "That would seriously get my attention."

Sometimes a simple eye exam can help detect disease in individuals who haven't been diagnosed. VSP Vision Care has "hundreds" of anecdotal examples where doctors found evidence of high blood pressure or diabetes or cancer, said Don Yee, senior vp of marketing and corporate development in Sacramento, Calif. "Yet there was no organized method to collect information... and to coordinate care with primary care physicians, and that's what Eye Health Management is really all about."

In the first year of the pilot program, called Eye Health Management, with the State of California, VSP doctors examined 60,000 state employees, 85 of whom were diabetic and didn't know it or were not being medically managed. On those cases alone, Greg Beatty, chief of benefits with the state's Department of Personnel Management in Sacramento, figures the state avoided $340,000 in costs associated with managing the disease.

Currently, only state workers who are members of Blue Shield of California participate, but Mr. Beatty hopes to persuade other health plans to join the effort. "If we could engage our other health plan providers and get the whole workforce in, we'd probably be exceeding a million dollars a year (in savings) right now," he said.

Despite the upside, most new vision plans are offered on a voluntary basis, with employers paying only a portion of the premium--or none at all. Benefit managers are pre-occupied with major medical, pharmacy and other health benefits, Mr. Yee said. "Vision benefits are probably 2% or 3%...of the overall health care dollar."

For California, which spends upwards of $3 billion in health premiums for state workers, a $1 million savings, Mr. Beatty admitted, is a drop in the bucket. "But," he added, "every little bit counts."