A Line of Sight

Companies are finding that vision plans can do more than just help their aging workforce with eye care. But getting employee buy-in isn't necessarily a snap.

By Jeffrey S. Eisenberg

Like other companies, Vectran wants to retain and attract talented employees. So, its HR staff constantly evaluates its health benefits to ensure they are competitive. However, when the Evansville, Ind., energy holding company did benchmarking studies in partnership with a healthcare consulting firm, one difference became apparent: Although the company's medical plan allowed employees to receive eye exams, it did not offer a standalone vision plan -- unlike 70 percent of the other companies in the energy sector.

Vectran wasted little time in obtaining a vision plan for its employees.

"Over the last couple of years, we have transferred into a culture of wellness," says Holly Boeke, manager of health and welfare plans. "[We are] trying to develop that, and believe that establishing this vision plan is [an important part of] this strategy.

Maurice Evans, director of human resources at The Integral Group in Atlanta, found himself facing a different challenge. The Integral Group, a real-estate development company, began offering its 250 employees a vision plan several years ago. But an employee survey revealed that most of them didn't even know about it.

Evans' situation isn't unique. Research supported by Transitions Optical, a Pinellas Park, Fla.-based company that provides photochromic lens technology, found that one in four employees do not enroll in their company's vision plan. Of those who do enroll, nearly one-third do not receive eye exams. And, only four out of 10 parents have taken their children to eye doctors within the past year.

These finding suggest companies need to do a better job of helping employees understand why they should enroll in the company's vision plan, go for an eye exam and obtain whatever corrective aids the doctor recommends. What makes this even more compelling is the fact that eye exams have proven to be an effective method for detecting chronic conditions (such as diabetes and high blood pressure) early on.

"The challenge today is all about educating," says Pat Huot, Transition Optical's director of managed care.

The Presbyopia Factor 

Transitions Optical's recent annual conference featured a panel discussion about getting employees to buy into their companies' vision benefit. The accompanying report, The Role of HR Managers in Vision Benefit Engagement: Focus on an Aging, Yet Active Workforce, features data gathered from myriad sources, including the Census Bureau, research firms, professional associations and medical literature.

One finding was clear: The workforce is growing older, which underscores the need for employees to have -- and use -- a vision plan.

Just ask Mark Weinstein, president and CEO of the Independent Colleges and Universities Benefits Association.

"Because the average age of employees we cover is 47, vision benefits are an extremely important part of the total benefits package," he says. "As we get older, vision health and vision care becomes more important.

According to the 2010 Census, approximately 82 million people in the United States are between the ages of 45 and 64, a 31-percent increase since the previous Census. Thanks to the recession, people are also putting off retirement, with four in 10 baby boomers past age 55 still working.

This population typically has several vision-related needs, as highlighted in Transitions' report. For example, most people require correction for presbyopia -- a condition in which the lens of the eye becomes rigid and loses flexibility, meaning that it cannot focus on close objects -- by age 45.

Also, about 90 percent of older Americans take one or more prescription drugs per week, many of which may have ocular side effects. These include antihistamines, pain relievers, antidepressants, steroids and inhalers, erectile dysfunction agents, and certain herbal and nutritional supplements.

Other needs extend to the workplace. For example, inaccurate vision correction, no matter how slight, can reduce productivity by up to 20 percent and can contribute to "computer vision syndrome." One in four employees ages 45 or older requires breaks to rest hurt or tired eyes. The cost to employers is about $2,100 per year for every employee who experiences eye strain.

And, as individuals age, their risk for ocular diseases -- including dry eye, cataracts, diabetic retinopathy, age-related macular degeneration and glaucoma -- increases. Indeed, one in three is expected to develop an eye disease by age 65. In a survey of its own employees, Transitions Optical found that 6 percent of employees ages 45 to 64, and 17 percent of employees older than 64, already have an ocular disease.

As people age, they also tend to develop more systemic problems, such as diabetes, hypertension and high cholesterol. Signs of these may be initially present in the eye, making an eye exam a key part of the patient's healthcare.

Early Detection

A vision plan is also key to lowering a company's healthcare costs. A study released by Rancho Cordova, Calif.-based VSP Vision Care last year revealed that its clients achieved $4.5 billion in healthcare savings through the early detection of chronic diseases during eye exams. More specifically, they achieved $2 billion in cost savings associated with diagnoses of hypertension, $1.7 billion associated with diagnoses of high cholesterol, and $800 million associated with the diagnosis of diabetes.

Human Capital Management Services Group, a Cheyenne, Wyo.-based national consulting firm that conducted the study for VSP, studied data on medical conditions of more than 200,000 VSP members over two years. HCMS compared chronic patients who were first identified during an eye exam with those identified by another doctor.

More than 43 percent of the individuals studied had diabetes, high cholesterol and hypertension, the researchers found. These conditions were first identified during an eye exam in 9,000 individuals. Also, the eye care providers in this study were the first to detect signs 65 percent of the time for high cholesterol, 20 percent for diabetes and 30 percent for hypertension. 

Employees in whom chronic diseases were detected earlier were more likely to be proactive and see a medical doctor for follow-up care.

Based on HCMS' database of medical and prescription costs and costs related to absenteeism, disability, worker's compensation and productivity, the study concluded that every $1 an employer invested in an eye exam during an employee's first year with the benefit yielded an average two-year total return of $1.27 in long-term healthcare savings. These savings are a result of avoided medical costs from complications and co-morbidities, thanks to early detection.

Additional savings were seen in healthcare costs, such as emergency room visits, medication costs, and inpatient care; savings on cost of lost time due to disability, and savings related to increased employee productivity. Indeed, among the employees studied, there was 7-percent less absenteeism, 4-percent less employee turnover, and savings on insurance and workers' compensation costs.

But, employees must first understand the importance of an eye exam. "A lot of employees really don't understand the value of a vision benefit unless they know they need vision correction," says Susan Egbert, VSP's director of eye health management.

However, there are several things companies can do to educate their employees about the importance of a vision plan.

Ask the Plan

When Evans -- who served as one of the panelists at this year's Transitions Optical conference -- first joined The Integral Group three years ago, utilization of the company's vision benefit stood at about 30 percent. Since then, the company has been more proactive in educating employees about the benefit and the importance of vision care as part of an individual's overall wellness effort.

Since then, plan utilization has doubled, to 60 percent -- something Evans attributes to the company's education efforts. "As we provide ongoing communication, [employees] can see the value [of purchasing] this benefit," he says.

Oftentimes, the vision plan or ophthalmic-products manufacturers can help companies educate their employees. For example, Transitions Optical provides The Integral Group with monthly reminders to email to employees. Messages have included information about how age, gender and race can affect vision, the importance of vision care for children, and the importance of protection from ultraviolet rays.

The Integral Group also makes available tools such as Transitions' Healthy Sight Calculator, in which employees can learn about the risks of various eye-related conditions based on their age, gender and ethnicity, and calculate the costs in terms of time, money and sight they could avoid by making use of their vision plan.

As a company that works with employers and insurance plans to improve workforce health and reduce healthcare costs, Franklin, Tenn.-based Healthways is aware of how a vision plan fits into an overall health strategy. The company lets its 3,000 employees know about the vision plan through annual enrollment materials, the employee newsletter and the company intranet.

Employee education on the matter is simply too important to be left just to open-enrollment periods, says Amy Moore, Healthways' former director of benefits.

"Make sure they maximize the benefit," says Moore, who's now the firm's well-being design leader.

VSP offers its clients workplace posters, materials for observance of events such as "cataract awareness month," and spokespeople who can talk with employees during benefit fairs. Through its diabetes program, VSP sends reminders to any diabetic patient who has not had an annual eye exam.

Another plan, San Antonio-based Davis Vision, often provides language that companies can include within benefit booklets, posters and mailers, if needed. The company also offers clients staff training, especially for employees in remote locations.

"This can be done via a webinar or in person," says Bernie Dal Cortivo, Davis Vision's senior vice president. "We partner with the HR staff to best understand their population and how to best communicate to them,"

For example, communications may depend on the demographic of a particular group and their ability to access technology. "For all groups, some consideration needs to be addressed for getting information to the employee home, where the spouse can review the open-enrollment literature," Dal Cortivo adds. "It isn't uncommon for the wife to make the benefit decisions when the employee is a male."

Moore adds that the two main goals for employers should be keeping workers and their families healthy. "And you want to keep them engaged," he says. "Any time you can do this through your partners, you want to maximize that data."

A Material World

While a comprehensive exam is an important starting point, employees are more likely to participate in a vision plan that covers materials -- namely, eyeglasses and contact lenses.

"In general, people over a certain age need vision correction, and they're more likely to get it if they have a good vision plan with a materials benefit," Egbert says.

By contrast, when vision is tied into medical benefits without a material benefit, utilization is low. A study conducted for the National Association of Vision Care Plans in 2010 reviewed eye-exam usage patterns of nearly 85 million Americans enrolled in vision benefits programs during the previous two years. Results showed that individuals who participate in full service, stand-alone vision insurance plans are two times (33 percent) more likely to receive an annual comprehensive eye exam than those who have vision-care coverage "bundled" with their major medical plan (16 percent). The study reviewed eye-exam usage patterns of nearly 85 million Americans enrolled in vision benefits programs during 2008 and 2009.

"But, if you have a full plan that has an exam and materials, employees are much more likely to use it, and they're likely to see the value [even] if they don't understand the health value of an eye benefit," Egbert says.

One caveat, however: Egbert recommends choosing a plan that has an outreach program and works with the company's medical plan. For example, VSP provides individual patient data in a HIPAA-compliant way to the medical plan so that the health plan can also educate those employees whose eye exams reveal an underlying medical problem. VSP also provides aggregate data to the employer.

"That integration is really important to us in terms of helping our employees live longer, stay healthy and take care of themselves, which ultimately reduces our healthcare costs," Boeke says.

Employers might also want to emphasize the reputation of the plan itself, which means checking first on the plan's provider network and confirming it provides excellent customer service.

"In the request-for-proposal process, I would encourage everybody to really ask the tough questions and check the references of these vision carriers," Weinstein says.

Money Talks

Of course, one way to encourage employees to enroll in -- and use -- the vision benefit is to prove its financial worth. For example, Evans says his company's vision plan encourages employees to get their eyes checked regularly by offering an annual eye exam with a $10 co-pay, no charges for lenses and a $130 allowance toward frames every other year. If employees choose designer frames that cost more than $130, they get a 20-percent discount on the balance of the cost, which they are then responsible for. The company also offers the $130 allowance the next year toward contact lenses.

"A vision plan, taken through payroll deductions, also is an economical way to pay for vision services rather than having to pay for the entire experience at the time of service," Dal Cortivo says.

The Transitions panel also suggests explaining how employees can use their flexible spending accounts to cover any additional eye care or eyewear expenses not covered by their benefit, such as premium lens upgrades or a second pair of eyeglasses. This is done on a pretax basis.

In fact, many vision plans are employee-paid through a section 125 plan, which provides additional value via pre-tax elections, says Dal Cortivo.

The Independent Colleges and Universities Benefits Association has found that an effective way to get employees to enroll in its vision plan offerings is to present them with a four-year rate guarantee with no premium increase. The premiums are less than $4 a month for a single employee and less than $11 a month for the employee plus family, says Weinstein.

"It's a real selling point," he says. "Add to that the tax advantages, and it's a no-brainer."

See these findings from a recent survey of employees at companies that offer vision plan benefits.

Sep 2, 2012
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