Analysts at a unit of UnitedHealth Group Inc. (NYSE:UNH) have used their member data to quantify how often vision plans can identify enrollees who are unusually likely to file catastrophic claims.
Agents who sell vision plans often tell employers and workers that getting regular vision screenings can improve overall wellness levels. The drafters of the Patient Protection and Affordable Care Act (PPACA) included provision requiring health insurers to include some vision care benefits for children in all PPACA-compliant individual and small-group medical coverage. But getting fresh, believable numbers to show how eye exams affect medical claim risk in a commercially insured population can be difficult.
Dr. Linda Chous, the chief eye care officer at UnitedHealth’s UnitedHealthcare unit, and Dr. Thomas Knabel, a vice president at the company’s Optum unit, came up with numbers by looking at the experience of 820,000 enrollees who had both UnitedHealthcare medical and vision coverage for at least 670 days in 2011 and 2012, and who started 2011 without having any chronic condition diagnosis.
The analysts looked at which enrollees received chronic condition diagnoses in 2011 and 2012, which providers first detected the chronic conditions, and what percentage of enrollees went on to get medical attention for the conditions.
The analysts found that 52,408 of the enrollees, or 6.4 percent, received chronic condition diagnoses, and that 2,612, or 5 percent of the enrollees who received chronic condition diagnoses, first learned about the conditions when they saw eye care providers.
Eye care providers created a “re-engagement opportunity” by filing a chronic condition claim for about 1,600 of those patients on the same day that their conditions turned up during eye exams.
For a look at what Chous and Knabel found about vision exams and re-engagement opportunities for three conditions that often lead to catastrophic claims, read on.
1. High cholesterol
Eye care providers filed only 166 same-day claims reporting that they had detected unexpected signs of high blood cholesterol levels in their patients.