Vision Benefit Breaks Out of Its Silo

At least one benefit provider is now giving vision practitioners access to its patients' pertinent medical histories and, in turn, sharing the vision-related caregivers' results with the larger healthcare system.

By Carol Harnett

Every once in a while, I like to revisit a basic employee benefit to consider whether anything has changed. It's a good reminder that, while health insurance and associated programs such as wellness and prevention benefits are moving targets, most benefit-plan designs remain relatively stable. And sometimes there is simply something soothing about a straightforward, practical analysis.

I seem to do this exercise about once a year. In 2011, I looked at dental insurance and, in 2012, I reviewed pet coverage (a benefit that feels new but has been offered in the United States since 1982).

To be honest, vision benefits came to my mind as reading menus in poorly lit restaurants became an increasing challenge for me. A few months ago, I became the not-so-proud owner of "cheaters."

Much like with dental insurance, I decided to forgo this popular employee benefit as a small business owner. I considered a variety of cost assessments as well as It seems in the years an employee needs an exam, and replacement frames and lenses, the cost of vision insurance is net-neutral. Regardless, employees value vision coverage and, by some reports, it is the second most popular voluntary benefit offering.

I will spare you the analysis I could provide on the prevalence of vision impairment, problems and disorders (more than 150 million Americans alone use corrective eyewear), or the estimated impact on productivity ($48.4 billion), or the reported return on investment to employers offering vision coverage (as much as $7 to $1, which, yes, seems questionable to me). The reality is that many employers offer vision benefits (82 percent, according to SHRM's 2013 employee benefits research report), and their workers appreciate it.

According to Jeff Spahr, president of WellPoint's vision, voluntary, life and disability business, the core vision-insurance benefit hasn't changed over time.

"The options haven't changed," says Spahr. "The allowance for frames, lenses and contact lenses hasn't changed; and the benefits design hasn't changed. About the only thing that's different is the shift from an employer-paid benefit to a voluntary arrangement."

Spahr must be right about that. I put out multiple requests on Twitter, LinkedIn and Facebook to speak with vendors and employers about innovation in vision benefits. WellPoint was the only company to respond.

What allowed vendors such as WellPoint -- which offer health insurance as well as a full array of other group benefits -- to "fundamentally make giant leaps forward," according to Spahr, is their ability to move the vision benefit out of its "disconnected product silo" and cross it over to the larger body of health benefits and its associated data.

Employers, meanwhile, have nothing to do with release of information or the authorization of release of medical information. The insurance company can share information among medical practitioners as part of the provision of patient care.

Spahr believes sharing data makes the difference, and "the two-way sharing of information improves care at both ends."

So, what does Spahr mean when he says that? Essentially, WellPoint is giving vision practitioners access to its patients' pertinent medical histories (including major diagnoses, laboratory results and prescription-drug histories and renewals) and, in turn, sharing the vision-related caregivers' results with the larger healthcare system. This network can include the patient, the primary care physician and an insurance-company health coach.

In other words, in a perfect world, the eye-health provider receives the patient's larger medical history and then shares the results of the eye examination back into the system. From there it goes into the member's clinical profile where it is subject to a monthly risk stratification algorithm. This triggers an appropriate response, which can range from something as innocuous as a postcard to the employee to a call from a health coach to an alert to the primary-care physician.

Spahr essentially believes this system is "leveraging every encounter in healthcare," which will ultimately lead to a total healthcare-cost model.

Now, I have no vested interest in WellPoint (although they hired me in the past to speak at a conference). But, here's what captured my attention.

I worked for a stand-alone ancillary line carrier. One of our differentiators was that we partnered with an array of health-insurance carriers to share data and occasionally case and claim management. Our belief -- which I supported -- was that the advantage to the employer was the ability to partner with the "best-in-class" vendor for each employee benefit instead of being locked into one carrier.

But here's what our model could not do. We were not able to feed data to the healthcare practitioners, particularly on a proactive basis before they saw their patients. And the practitioners were not able to feed their data back to us, or the larger medical history.

As human resource executives, the ability to provide your employees with complete clinical profiles, which includes them as well as their healthcare providers and health coaches is, at a minimum, a concept worth keeping your eyes on.

Carol Harnett is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, and value-based health. Follow her on Twitter via @carolharnett and on her video blog, The Work.Love.Play.Daily.

Nov 18, 2013
Copyright 2017© LRP Publications