How a utilization-driven vision plan can cut health costs and catch disease early
The vision benefits conversation in most broker offices begins and ends with price. That, says Dr. Don Railsback of Vision Care Direct, is precisely the problem.
Railsback, an optometrist and co-founder of Vision Care Direct – a provider-owned and operated vision plan based in Wichita, Kansas – says that treating vision coverage as a commodity race to the lowest premium strips out the very feature that makes vision benefits valuable to employers: utilization.
When employees avoid using a plan because they fear out-of-pocket costs at time of service, the preventative health screening that a routine eye exam delivers never happens and the downstream costs to a group health plan can be significant.
“The best thing to do with a vision plan is to implement a plan where you’re at least covering an eye exam for every employee,” Railsback said. “Oftentimes in the vision plan market, we’ll have companies coming in and they’ll try to buy business with a very low rate. And then like everything else in healthcare, they have to raise the cost of the plan each year as they see what the utilization is.”
The case for utilization-first vision benefits
Vision Care Direct structures its plans around low cost at time of service rather than low monthly premium. Railsback said the approach is designed to remove the sticker shock that suppresses participation in lower-premium, higher-cost-at-point-of-service plans.
“We want as a provider-owned and operated plan … people to use that plan,” he said. “We’re in the business for a little bit different reason than our competitors, in that we’re not as profit-driven.”
The outcome, Railsback said, is pricing stability: approximately 90 percent or more of long-tenured Vision Care Direct groups have never received a rate increase, in contrast to the annual cost escalation common in plans that buy business with an artificially low opening rate.
What the eye exam actually finds
The business case for utilization extends well beyond vision correction. A comprehensive eye exam, Railsback noted, can detect up to 270 health conditions that have nothing to do with eyesight. Diabetes is the clearest example with more than 100 million Americans pre-diabetic and unaware of it according to Centers for Disease Control and Prevention (CDC) data, and the eye provides a unique clinical window.
“When you go in for an eye exam, they’re going to look inside your eye, and when they look in there, they can actually see your blood vessels in their natural state,” he said. “Eye doctors get a really good insight about your cardiovascular, your vascular health, whether or not you’re at risk for hypertension.”
The exam also assesses immunological and neurological indicators, and a biomicroscope examination of the front of the eye can reveal early cataract formations which can themselves signal systemic disease. During his clinical career, Railsback said he identified choroidal melanoma – a tumor inside the eye – in three separate patients who presented with no symptoms and no awareness of any problem.
“One of the gentlemen I found it in, I only got to see him because his wife made him come in for an eye exam,” Railsback said. “He was 20/20 at distance and near. He had no issues whatsoever, but he had a tumor in his eye. We found it early enough that they were actually able to treat the tumor and save his eye.”
Had that tumor gone undetected and metastasized, Railsback noted, the cost to the employer’s health plan from long-term cancer treatment would have been “astronomical.”
Computer vision syndrome and employer productivity
Screen use has added a new and fast-growing dimension to the vision benefits conversation. Railsback described computer vision syndrome as a significant and rising problem. Because of the gap between a screen’s surface and the projected image, the eye is in continuous, involuntary refocus throughout the workday – a sustained muscular effort that produces headaches, eye fatigue, dry eye, neck and back pain.
“You can see after 8 hours of doing that, especially if you don’t take breaks, you’re causing a lot of stress and fatigue,” Railsback said. “That kind of stuff is skyrocketing.”
The productivity argument for employers is direct. Purpose-built computer eyewear, set for monitor distance, relaxes the eye and reduces end-of-day fatigue. Railsback said employees who wear computer glasses are more productive during working hours and less fatigued at the end of the day.
Railsback says ergonomics assessments can cut employers’ costs. In one case a single ergonomics review saved a company more than half a million dollars in anticipated health claims after identifying an employee whose workstation configuration was causing chronic headaches and wrist pain – prompting two planned surgeries that were subsequently canceled once the setup was corrected.
Given the high cost of health premium increases to employers, Railsback is clear about the benefits that eye exams bring.
“If we can positively affect that and also help people have a better quality of life and be more productive, then it’s a huge win for our employers,” he said.
What brokers can bring to the table
Railsback outlined several tools including annual utilization data so employers can see whether the plan is being used; access to existing research studies on health outcomes for employees with and without routine eye exams; lunch-and-learn sessions with employee groups; and diabetic screening services.
“Brokers that bring those types of things to employers, they’re going to be bringing a unique perspective over just price,” Railsback said.
The pitch, ultimately, is one of repositioning. Vision benefits – particularly when structured around exam-first, low-cost-at-service-access plans – function less like a traditional ancillary product and more like a preventative wellness program with a clinical edge.
For brokers working to demonstrate value beyond renewal pricing, that reframe may resonate with plan sponsors increasingly focused on total healthcare cost, workforce productivity, and early disease detection.
