Vision Quest

The value of vision benefits can extend beyond eye health. Having a thorough look inside the eye can tell a lot about someone's overall health. Yet the benefit is often overlooked by HR and employees alike.

Sunday, May 1, 2011
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In the eyes of many, Wendy Marshall is bucking the trend.

An assistant vice president of corporate benefits at Medstar Health Inc., Marshall makes sure that delivering effective communication about vision benefits to the Columbia, Md.-based healthcare system's 23,500 eligible employees is a top priority.

Through newsletters, e-mail, home mailers and total-rewards statements, Medstar's HR department communicates the value and importance of utilizing vision benefits throughout the year -- not just at open enrollment.

And its main audience doesn't wear glasses or contacts.

"We tell employees, 'Even if you don't think you have any vision problems, you should enroll in this benefit, take advantage and get your eyes examined at least once a year,' " says Marshall. "It's not just going to identify if you have a vision problem that's maybe gone undetected, but also [detect] other health conditions that can be uncovered during a vision exam."

Those conditions include diabetes, cancer, neurological disorders and even brain tumors, according to vision experts. Those ailments, as well as the health of the lens, retina and other eye parts, can't be detected in a routine eye-chart test, but can be found in a more thorough, comprehensive eye exam.

In fact, eye-chart tests only detect 5 percent of vision problems, says Dr. Peter Kehoe, an optometrist and professional-relations adviser at Transitions Optical Inc.

Nevertheless, not every company emphasizes the importance of vision care. Instead, many relegate it to "slide 63 of a 65-slide presentation" on healthcare, says Pat Huot, director of managed vision care at Transitions Optical, who spoke at the Transitions Academy 2011 conference in Orlando earlier this year.

Experts say HR devotes little of its communication efforts to vision benefits -- aside from open enrollment -- and it doesn't emphasize the reasons why employees should utilize the benefit. Medical benefits seem to get all the attention -- after all, their cost and complexity warrant it.

But the lack of emphasis on vision is doing quite a bit of damage.

Nearly half (48 percent) of U.S. workers don't take advantage of their company's vision benefits, according to Employee Perceptions of Visions Benefits, a survey of more than 2,000 employees by Pinellas Park, Fla.-based Transitions.

The survey also shows that 24 percent of people don't enroll in their company's vision benefit and, of those who do, 32 percent don't undergo comprehensive eye exams, either relying on eye-chart tests or skipping the exams altogether.

The toll on health is immense, as VSP reports that 1.7 million of its 56 million members were alerted to serious medical conditions such as diabetes and hypertension via eye exams, according to a spokesperson for the not-for-profit vision benefit and services company in Rancho Cordova, Calif.

Plus, eye-focusing problems can cause employers to lose 15 minutes per day, per employee, of productivity, according to Kehoe.

Many HR departments, however, seem to think they're doing a good enough job communicating about vision benefits, says Huot. "There's a huge disconnect," he says.

"The Window to the Body"

Having a thorough look inside the eye can tell a lot about someone's overall health. How's the eye's coloring? Are the arteries and veins both identical in size? Do the blood vessels leak?

The answers could show, in some cases, conditions that may be potentially life-threatening.

"The eye is the only place where we can see blood vessels without cutting [into the body]," says Kehoe. "That's why the eye is the window to the body."

For example, blood vessels that are different sizes or have unusual shapes could be a sign that a person has high blood pressure, says Kehoe.

During a comprehensive eye exam, the doctor will evaluate the front, back and inside of the eye. Patients with high cholesterol often have a grey ring, or arcus, around the iris -- the colored part of the eye, says Kehoe.

Very serious conditions such as cancers can also be detected during these exams, by evaluating the front or back of the eye for certain types of bleeding, called retinopathy, he says. Retinopathy can also be a sign of diabetes or hypertension.

Brain tumors can even be discovered through an evaluation of the retina or when a patient's peripheral field of vision is compromised, he says.

While eye doctors have known about this information "ever since doctors have been looking inside people's eyes," says Kehoe, it doesn't seem to be common knowledge among the public.

That's why HR departments should reach out to employees about vision care, he says.

At Medstar, two-thirds (67 percent) of eligible employees elect to have vision coverage -- even though half must pay the entire premium on their own, says Marshall.

"The associates here value the benefit," she says, adding that the company plans to expand its outreach to discuss the importance of getting employees' children's eyes checked. Indeed, the issue really hits home for Marshall, who found out -- just in time -- that her son had a lazy eye that could be corrected without surgery.

After he turned six years old, doing so would have required an operation.

"The vision tests they do in the schools are so quick, it's very easy for a child to slip through those screenings," says Marshall. "We are going to start emphasizing the importance of vision exams, even in very young children." (It seems to be a worthwhile idea, since a Transitions study shows 46 percent of parents don't get their children comprehensive eye exams -- see sidebar.)

Skeptics and Believers

Not everyone thinks HR needs to devote significantly more time and resources to promoting vision benefits. Helen Darling, president of the National Business Group on Health in Washington, thinks communication can only go so far.


She says vision benefits are usually delivered in "three sentences" by HR or a benefits administrator.

"Does it cover the eye exam? How often? Does it cover contacts and glasses?" she says. "That's it. There's not much more you can say. Everyone knows what it is."

But that's OK, she says, because HR "only has so many messages [it can] push."

Almost all of the large companies that make up NBGH's membership offer vision benefits, says Darling; however, in a recent survey only 24 percent called the benefit "important" or "very important."

Darling says those numbers are low only because people are comparing vision to medical benefits, which are much more sought-after and complicated to explain than vision.

Darling also cautions against placing too much emphasis on eye exams being used as ways to detect certain health conditions or diseases. While it's clearly a good thing to get checked, she says, one should not rely on an eye exam to detect those ailments.

"You certainly don't want people thinking, 'The way I get my annual checkup is through the eye doctor,' " she says. "You really want to drive people to have an ongoing, continuous, caring relationship with their doctor, whose specialty is taking care of all of you."

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Nevertheless, vision benefits are clearly important, says Darling -- and companies should recognize their value.

"You want people at their optimal, and you can't work at your optimal if you have vision problems," says Darling. "So, the biggest argument for good vision care is that it's part of a package for a healthy, productive and resilient workforce."

Stephanie Jackson strongly believes in the importance of emphasizing the value of vision benefits to employees. Her employer, the County of Halifax in Virginia, revitalized its vision program in 2009. Today, the 165 county employees who are eligible for vision benefits can go to a variety of eye doctors in the region. Before, just one local doctor participated in the program.

To promote the vision plan, the company focused on including educational materials in its enrollment guides -- stressing that eye illnesses can be prevented or cured more easily upon early detection.

Jackson, director of finance for the county's board of supervisors, says the results have been "astronomical."

Now, 85 percent of eligible employees utilize the benefit. Numbers hovered near 40 percent before, she says. The difference has been educating employees about the value and affordability of benefits. "That was just from getting the information out, making them aware," she says.

She expects the county will see a fiscal benefit.

"Through the greater education of our employees, our medical claims will be positively impacted," she says. "[The claims] won't be as substantial if we're able to catch illnesses early."

Reducing the Blur

Employers may be starting to see the light, says Ken Stellmacher, director of client and member marketing at VSP.

"We believe they are placing more emphasis on vision, in terms of how they promote it to their employees," he says, noting that more and more employers are seeing the connection between eye health and overall health.

However, it takes more than just communication to drive up vision-care utilization, he says. HR executives may want to consider a full-service, stand-alone vision-insurance plan. Employees in these plans are twice as likely to receive annual comprehensive eye examinations than customers who have vision-care coverage "bundled" with their major medical plan (33 percent versus 16 percent), according to a 2010 study by the National Association of Vision Care Plans in Louisville, Ky.

Another way to increase utilization is by integrating vision into a company wellness program, says Stellmacher, perhaps by giving employees incentives for getting their comprehensive eye exam every year.

"It gives the company another chance to get the employee into the healthcare continuum," he says. "This, coupled with a plan that employees value along with strong internal communication, makes for a winning utilization formula."

Certainly, communication is still top of mind for VSP. It offers clients signage, fliers and e-mail, as well as benefits fairs and a website that can be linked to a company's intranet.

"I think we're realistic about how much time employees spend thinking about their vision benefits, compared particularly to their health benefits," says Stellmacher. But the company tries to "make vision care relevant to [its clients' employees] on an ongoing basis, reinforcing the importance of taking care of your eyes."

Joe Part, founder and managing partner of Alltrust Insurance in Palm Harbor, Fla., and a speaker at the Transitions Academy 2011 conference, says the success of vision benefits rests on education -- and it can't just be a "quick talk."

"Success is a reflection of understanding by the employee," says Part. But a once-a-year handout won't cut it.

"Nothing is more powerful than doing this in person," says Part.

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