Seeing beyond size in vision care networks
How do you measure the quality of your vision care network? When it comes to the world of vision care, size isn't the only factor to consider when deciding which network best fits the needs of your employees. Read on to learn more.
Most people believe that “size matters” in regards to provider networks, but in the world of vision care, there are other important factors to consider when deciding which network matches the needs of employees. Network members usually see their vision provider for routine services just once per year. When an employer changes vision administrators, employee in-network utilization is more than 90% regardless of the new network size. Why? Employees are not concerned about changing providers to access in-network benefits. Plus, the new vision provider network will always provide access to multiple providers wherever the employee lives and works.
But what about the quality of the vision care network? To properly assess this measurement of competing networks, employers and benefits advisors need to ask several different questions.
Determine the network’s quality
The quality of the network is vital. Start asking these questions: How are vision care providers credentialed? Do they follow the National Committee for Quality Assurance (NCQA) guidelines developed to improve healthcare quality? Are there provider audit programs provided on an ongoing basis? Is the vision care provider re-credentialed and how often? How frequently are reviews conducted of the Office of Inspector General and Medicare and Medicaid disbarment lists?
Establish the network’s effectiveness
Once you know you have a quality network, now you must ask how effective the network is. How diverse is the network? Are there ample ophthalmologists, optometrists and optical retailers we can access? Are some private practitioners? You want to make sure that a solid provider mix is available to give employees options when choosing a vision care provider.
It’s critical to know what languages are spoken within the employee population as well as the providers who care for them. If you have a large population who speak a certain language you want to make sure your network gives them access to people who can truly understand them and with whom they feel comfortable.
Finally, look at the hours of operations. With schedules being busier now than ever before, people need flexibility when it comes to visiting hours. Do they offer evening hours? Weekend hours? This is particularly important for single parents who work during the week and need the flexibility to visit an eye care professional with his or her child after work.
Having a diverse, quality vision care provider network with convenient access helps keep employees happy, healthy and in-network.
Other factors to consider
One of the other factors to be cognizant of is network ownership. Today, many managed vision care companies are involved in not only providing coverage for vision care but also in delivering it. This means the vision benefits company you’re considering may own optical laboratories, frame companies or retail locations, which can pose conflicts of interest between you, your employees and the managed vision care company. Their need to produce profits can lead to undo pressure on your employees to purchase expensive and potentially unnecessary lens types, materials and options. Coupled with direct to consumer advertising and the expansion of brands, eyeglasses have become even more expensive.
This leads to another factor for consideration. Does the potential vision benefit administrator provide meaningful information to help your employees make informed decisions about what they really need, when it comes to the myriad of options available for frames, lenses and lens options?
Network matching
Start by remembering two things when matching networks. First, if you’ve changed vision carriers in the past, you selected a network that was not identical to your previous one. Vision networks never match each other. Some have higher proportions of independent providers and lower percentages of large retailer chains. Second, the infrequency with which the vision benefit is available to be used mitigates the impact of changing providers. People don’t have the same attachment to their eye care professional as they do with their physician.
Beyond quality and effectiveness is the important factor of access. The vision industry has grown to a point where there are often many more providers than would ever be necessary to provide convenient access for your membership. The reality is that two networks may be equally sized in an area and yet there may be little overlap, making the selection of the best network with the lowest overall cost a better strategic direction than simply selecting the one with the highest provider match.
The vision industry has long demonstrated that employees are willing to select new providers, especially when costs are more competitive, and services are more convenient.
SOURCE: Moroff, C (22 August 2018) "Seeing beyond size in vision care networks" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/seeing-beyond-size-in-vision-care-networks?feed=00000152-a2fb-d118-ab57-b3ff6e310000
Failing to See
By Marli D. Riggs
Source: eba.benefitnews.com
Baby boomers are not taking advantage of available eye care benefits, leading to lost productivity
Despite employees reporting a strong interest in their company vision program, today's workforce isn't taking full advantage of the coverage — especially baby boomers.
Baby boomers (age 45-64) are only slightly more likely than younger employees to enroll in their vision benefit (79% vs. 75%), according to Transitions Optical's Employee Perceptions of Vision Benefits survey.
"1-out-of-4 employees that have an opportunity to enroll in the program do not," says Pat Huot, director of managed vision care and online retail for Transitions Optical.
"Of those that do enroll, 1-out-of-3 employees in the baby-boomer age range and 1-out-of-4 in the 65-plus range have not used their vision plan at all in the last year."
Huot believes the industry is trying to make it easier for employers to help employees become connected with the importance of the annual exam and all of the other touch points associated with it, "but if employees don't use the benefit, there's no opportunity there for them to realize that benefit."
The consequences
Studies by The Vision Council, an Alexandria, Va.-based nonprofit optical trade group, show about $8 billion is lost by employers every year due to lost productivity that stems from employee vision issues.
"This is mainly because employees' eyes are either not in focus or they have debilitating eye conditions that aren't managed well, so they just aren't as productive as they could be," says Dr. John Lahr, the medical director at Cincinnati-based EyeMed Vision Care.
Dr. Lahr, who has been in the field for nearly four decades, talks about the need for correction, which becomes more prevalent as employees age. The crystal lens of the eye where cataracts form, he says, is very elastic and loses that elasticity as people age.
"Usually, those between 40 and 45 cannot focus optimally for close vision and require reading glasses, or if they already have glasses they might need a multi-focal application to be able to read," he says.
"This factor really hits the worker that's in their 40's, 50's and 60's and is looking at a computer screen daily," adds Dr. Lahr. "If you measure that distance in which they are viewing it's usually 22 to 24 inches, where the normal reading distance is 16 to 18 inches."
He adds that the focus of glasses or contacts for everyday use is not optimal for the computer screen.
"In turn, employees lose a lot of productivity because they get eye strain, headaches, and they're also leaning forward in unnatural positions."
"In 2006, the very first baby boomer turned 60," says Transitions Optical's Huot. "As a snapshot of where we are as a country in terms of an aging workforce, it amazes me that every 10 seconds from that point in 2006 until 2023 someone in the U.S. will turn 60."
At age 40 employees should start protecting their eyes against serious diseases such as cataracts and macular degeneration - neither of which has symptoms in the early stages, says Dr. Lahr.
He adds that these diseases are much more prevalent in blacks and Hispanics.
"We find there are profiles where we can draw to try to assess risks and try to be more cautious with those individuals."
The obstacles
According to the Employee Perceptions of Vision Benefits survey, not having vision or eye health problems is the most commonly cited reason for not enrolling in a vision plan. This shows a lack of understanding of the importance of preventative eye care, says Transitions Optical's Huot.
He and his team encourage brokers to motivate their clients by giving them an interactive set of tools.
For example, his company's Healthy Sight Calculator helps clients educate their employees, calculate costs and learn about potential ROI with their vision plan.
"High profile tools, such as an online calculator, are designed to help the employees become more engaged around how a vision benefit connects to total health care versus" mentioning it as an afterthought in a larger presentation about health benefits, he says.
"We have yet to meet that broker that says, 'My clients can't wait to talk about vision!,'" adds Huot with a laugh.
EyeMed Vision Care tries to create an awareness of routine eye care and the associated benefits by providing an identification card that plan participants can put in their wallet to serve as a reminder during the year, says Dr. Lahr.
A personal experience
A decade ago Patrick Tibbs of Everence Financial Advisors in Indiana began to experience pressure in his eyes. He went in for a routine eye exam where the ophthalmologist determined his symptoms could be a cause of glaucoma.
Tibbs now goes once a year to have his eyes checked and glasses dispensed. He says by taking preventative steps for his own vision he feels a personal satisfaction knowing that employees are doing the same.
Vision care benefits are "near and dear to my heart," he says.
Vision benefits play a key part in motivating employees to see an eye doctor for a comprehensive exam.
EyeMed Vision Care's Dr. Lahr has seen in studies that those who have vision care coverage are more likely to get preventive eye exams even if they don't have symptoms.
"Our average utilization of a voluntary benefit where an employee defers money out of their paycheck we see about 35%," he says.
One factor keeping that utilization rate from rising is a misguided assumption that "if I see well [then] there's nothing wrong with my eyes."
Tibbs says baby boomers who are paying higher premiums for health insurance at the same time they're seeing their 401(k) values drop, yet still having to cover dependents with out-of-pocket costs, could be avoiding routine eye care "because they can't afford to pay $75 to $100 for an eye exam, then pay $300 for a pair of glasses."
Vision care is the summer
In the summer months employees' calendars are filled with vacations, parties and other outdoor festivities. Protecting eyes from ultraviolet rays is a must - but that is not the only one to be careful of, says Dr. John Lahr, medical director at Cincinnati-based EyeMed Vision Care.
In ophthalmology there is a new acronym to account for as a contributor to the development of cataracts and macular degeneration: high-energy visible light.
"This is the blue spectrum which we would see longer wavelength that is closer to the UV spectrum," says Dr. Lahr. "It has been studied through longitudinal studies which measured people's development of the two key eye diseases," cataracts and macular degeneration. "Since both of these eye diseases are much more prevalent in individuals that have high exposures to UV light, now they're starting to break down where they are when they're exposed," he adds.
As employees age, they have a heightened risk for cataracts that can impair performance at work," says Indiana broker Patrick Tibbs. "Out of 20 million people with cataracts it's estimated that 20% of those are caused by ultraviolet rays. Having proper eye wear is important and it will help with productivity." -Marli D. Riggs
