By Elizabeth Klunk
What does medical management truly mean when it comes to managed vision care and benefits? Traditionally, medical management has referred to insurers and medical professionals working together to improve care quality, outcomes and costs. However, the U.S. healthcare ecosystem is continuing to rapidly evolve—with healthcare venture capitalist fundraising reaching record highs in 2018, according to data by PitchBook—and the concept of medical management has been heavily adapted and consequently muddled.
Keeping the end goals of better member outcomes and controlled care costs in mind, health plans must consider medical management by its truest definition—utilization management—and with eye health as a growing cost specialty, now is the time for vision benefits to drive the conversation.
There’s More To An Eye Exam Than Glasses
During routine eye exams, in addition to recommendations for corrective wear, eye care professionals may uncover medical eye issues or overall health concerns, which are, then, entered into claims review systems. This is where medical management begins—through this starting place, managed vision care providers with true medical management capabilities can enable continuity of care, peer communication and evidence-based medical policy criteria application, while avoiding leakage and overspending.
What this looks like for health plan members is: no delays in medical care, broadened access to medical vision care services and little need for referrals and costly follow-ups, all critical components of a healthcare environment focused on care integration and efficiencies.
And nowhere is this more important than when it comes to pediatric vision care. In some cases, it can mean the difference between scholastic excellence and a misdiagnosed label.
Juvenile Delinquency, Learning Disorders and Vision
While most parents are consistent when it comes to taking their children to the pediatrician for regular wellness exams, research shows that they are less vigilant about their children’s vision. According to the Better Vision Institute, only 14 percent of children have had a comprehensive vision exam before they enter first grade.
This belies the American Optometric Association’s guidelines that all children should have had three exams by this time: one at six months, one at age three and one again before entering school. The reason? One in 10 children is at risk for an undiagnosed vision issue.
While many schools do perform vision screenings on site, studies show that these basic screenings (such as the Snellen eye chart) only detect 20 to 30 percent of vision problems in schools–meaning that nearly 80 percent of children with vision issues are getting lost in the shuffle, often incorrectly labeled as having a learning issue. This was seen in one study, where researchers discovered that 95 percent of nonreaders in first grade had significant vision problems. In fact, they had nearly 2.5 times more visual problems than first grade high achievers.
When you consider that UCLA doctors found that 80 percent of learning in the classroom is visual, it makes sense that when children cannot see, they likely cannot learn either. When kids are better able to see a classroom board and read the words in a book, they are not only more confident about participating in class, but the class overall experiences fewer disruptions.
The importance of vision care to overall wellness is also echoed in the California juvenile detention system. Researchers found that 35 percent of adolescents in juvenile detention centers had uncorrected refractive errors, as compared to 22 percent in the public school system. Even more telling is that when the children in the system received on-site optometric vision therapy, recidivism (repeat offenders) reduced from 45 percent to just 16 percent.
Clearly leveraging vision benefits is about more than just checking people’s ability to read or see distances. Eye exams provide an inside look at overall health, manage costs and risks around chronic diseases and may even help keep children in the classroom, achieving their dreams.
Elizabeth Klunk, RN, BSN, CCM-R, is the Senior Vice President of Medical Management at Versant Health, a managed vision care company focused on creating an integrated and seamless experience for health plans, members and eye care professionals across the total eye health value chain.