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UnitedHealth team measures eye exam risk-catching power

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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.

See also: What PPACA could do to your clients’ ears

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.

See also: Optometrists see gaps in essential health benefits

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.

Clogged arterty

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.

Only 8 percent of the patients involved went on to get medical care for their conditions within 60 days.

See also: WellPoint: The Future Looks Blurry – And, For Many, So Does E-Mail

Blood pressure check

2. High blood pressure

 

Eye care providers filed just 141 same-day claims reporting that they had detected unexpected high blood pressure levels in their patients.

But 24 percent of the patients involved went on to get medical care for their conditions within 60 days, potentially reducing the risk that they would experience strokes or other crippling, catastrophic conditions.

See also: Americans with Standalone Vision Plans Twice as Likely to Receive Eye Exams

Diabetes test

3. Diabetes

Eye care providers filed 1,253 same-day claims reporting that they had detected unexpected symptoms of diabetes in their patients.

About 38 percent of the patients involved went on to get medical care for their conditions within 60 days, potentially reducing the risk that they would experience any of the many potentially crippling, catastrophic conditions associated with diabetes.

See also: 9 things you probably didn’t know about your health savings account