Medical Management as a Tool to Improve Eye Health Quality and Reduce Costs

Optimal eye health is the gateway to overall wellness. Without a proper care plan in place, it can be difficult to make arrangements for eye care and detect vision issues as well as potential diseases. That’s why managed eye care is critical for health.

Posted October 21, 2020

We all appreciate the importance of good vision. In fact, blindness ranks as one of the top fears of aging Americans, along with stroke, Alzheimer’s disease, diabetes, and heart disease. During a routine eye exam, eye care professionals look for a lot more than just vision correction. They are also looking for medical eye concerns such as cataracts, glaucoma, macular degeneration, and diabetic retinopathy so that patients can benefit from early detection. Approximately 10 million people (30 percent of diabetics) have diabetic retinopathy, a potentially blinding disease that costs Americans more than $500M every year. In all four cases, a routine eye exam can detect the signs and symptoms of each of these eye conditions in the early stages.

However, few people appreciate that an annual eye exam has long-reaching benefits beyond just vision correction, glasses, and/or contacts. In addition to detecting the leading causes of blindness, an eye exam plays a critical role in the early diagnosis of more than 30 chronic medical conditions, often before the patient has symptoms.

Through a true utilization management model, health insurance plans can provide their members with quality throughout the continuum of care while reducing eye health-related costs. A member-focused approach can help to improve patients’ experience of care, enhance overall population health and reduce per capita cost of healthcare by providing the right service, at the right place, at the right time.

Generally, the rise of medical eye care costs year over year outpaces total Medicare costs, but utilization management ensures cost control. For example, eye-related costs drive 7.2 percent of total specialty care Medicare expenses ($102B). In fact, eye care costs overall have been growing at three times the rate of total Medicare spend. Savings is also demonstrated in the Medicaid member segment. For example, a comprehensive eye care Medicaid health plan demonstrated consistent cost reduction, generating a 17 percent change in volume across the highest utilized procedures.

Utilization management ensures appropriateness of services, doctors adhering to clinically defined protocols, and ultimately creates value for patients. It doesn’t assume that the most expensive treatment is necessarily the right one. Rather, the frequency of necessary treatments is more critical.

Members whose health plans include utilization management receive benefits beyond routine vision exam coverage. Should their eye care professional detect an eye disease or chronic health condition, vision integration streamlines care delivery, minimizing referrals and facilitating follow-up appointments with specialists. This process helps to avoid delays in care, which can lead to the condition worsening and longer treatments. We coordinate the care so members can focus on more important things, like their health.

Our team at Versant Health flags any signs of chronic disease that are detected and reported during a routine exam. In this way, we are able to help patients pre-emptively manage the disease with their primary care physician long before they’ve had an episode of care.

Versant Health is able to ensure the appropriate level of service, eliminate network management costs (as we delegate to our optometrist and ophthalmologist network), and help to prevent fraud, waste, and abuse. Additionally, we help to eliminate administrative burden by handling all network claims, payments, and customer service for vision-related issues.

Finally, we are able to minimize leakage and overspending. First, all claims are integrated across all levels of vision care, allowing for ease of information to transfer across healthcare providers. Second, our customized diabetic disease management engagement policy works to improve quality scores in that population.

With its comprehensive focus on the continuum of care, utilization management is a best practice when it comes to managed eye care. It provides value for patients and health plans alike by helping to improve eye health quality and overall wellness while reducing costs.

For more information on our utilization management and vision plan offerings, visit versanthealth.com/services.

Medical Management as a Tool to Improve Eye Health Quality and Reduce Costs

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