Early Detection in Vision Care Catches the Eyes of Payers

It’s said that a person’s eyes are the windows to the soul—and it’s also becoming clear that eyes offer an important look into whole-body health. Vision care providers can be the first to detect early signs of serious systemic diseases. In fact, there’s an emerging field of oculomics developing around use of eye scans to identify and detect heart disease, kidney disease, diabetes, risk of stroke, sickle cell anemia and other conditions at an early stage. There’s also research indicating eye scans could help identify risk of Alzheimer's much earlier than ever. Dramatic growth in recent years of artificial intelligence (AI) diagnostic tools and analysis is helping drive this trend.

Eye Exams As a Cornerstone of Preventive Healthcare
Recognizing the value of eye exams in preventive healthcare, payers are integrating coverage of vision benefits with their medical health benefits plans: 

• Medicare Advantage (MA) plans: This year, 99% of MA plans include routine vision coverage, a significant increase over the past decade. Low-cost or free annual eye exams, and ample eyewear allowances are part of many MA plans. 
• Employer-sponsored health plans: Bundled options that combine vision and medical insurance under a single premium are offered by some payers. The integration can help employers save on premiums, and simplify access to both vision and medical care for plan members.

However, Medicaid plans lag behind commercial and MA plans in terms of vision benefits. As of 2023, Medicaid vision care benefits varied widely by state. About a dozen states did not cover eye exams at all, and in states that did, many had co-pays, which can be a barrier to accessing care for those enrolled.

Advantages of Integrated Coverage for Insurers
There are several potential strategic and financial advantages for insurers of vision-medical benefits integration:

• Increasing member satisfaction and retention, as plans that include vision may be perceived as higher value 
• Cost of care savings by catching larger health issues earlier
• Increasing efficiency and reducing administrative cost through simplified enrollment, claims processing, member communications, and provider contracting
• Differentiation in a competitive market   

Read how one Fortune 500 insurer was able to grow member lives by 20% and save $1 million in IT spend in a single year by consolidating dental and vision plans on SKYGEN’s SaaS benefits automation platform.

Moving Toward Clinical Integration
As integration of vision with medical coverage continues to grow, the next frontier is clinical integration. In this model, vision and medical care providers team up to provide more coordinated care for plan members. Clinical integration can lead to more personalized care and enhanced health outcomes. For members with hypertension, diabetes or other health issues that can affect vision, coordinated care could be especially valuable.  

Member engagement will be vital as models of care evolve. Active member participation can encourage greater use of preventive care, lifestyle changes to support better health, and member satisfaction.  

Talk with SKYGEN About Specialty Benefits Integration
As a leader in specialty benefits technology and transformation, SKYGEN can collaborate with payers on the core elements of a comprehensive integration program:

• Data — Through API technology, SKYGEN ensures real-time, secure connectivity between our benefits automation platform and payers’ systems to enable streamlined data flow. 
• Actionable insights — SKYGEN’s data analytics translate data into opportunities for plan optimization.
• Tools for member and provider engagement — SKYGEN’s member portal and member mobile app enhance member communication and outreach online for both payers and providers.

Let’s talk! Connect with one of our specialty benefits experts to explore how SKYGEN’s innovation, technology and expertise can support your move toward integrated vision and medical coverage and care.