How tech solutions can take aim at employee stress

Are your employees stressed? Stress can lead to multiple health conditions and many people cope with stress in unhealthy ways. Continue reading to find out how employers can help reduce stress in the workplace.


In case you haven’t noticed, today’s workforce is completely stressed out. Overwhelming workloads, looming deadlines and the 24/7 always-on mentality is becoming the corporate America norm. Unfortunately, long-term stress can contribute to everything from heart disease to strokes, cancer and other grave conditions. Stressed employees also are more likely to be unmotivated, quit their jobs, perform poorly and have low morale and higher incidence of illness and accidents.

Because everyone copes with stress differently, some deal with it in unhealthy ways, such as overeating, eating unhealthy foods, smoking cigarettes or abusing drugs and alcohol, according to the American Psychological Association. This vicious cycle makes stress one of the top health concerns, with 49% of individuals at risk for stress-related illnesses, second only to weight, which impacts 69% of individuals, according to internal research.

All in all, employee stress is causing employers … well, stress. In fact, the cost of work-related stress in the US is $300 billion annually, according to the American Institute of Stress. Further, behavioral-related disability costs have increased more than 300% in the past decade and account for 30% of all disability claims.

While more than two-thirds of US corporations have adopted some kind of health and wellness program, the majority doesn’t adequately address or even include solutions that support mental health. That’s why it’s critical to educate employers on the real cost of stress and the benefits of an effective stress-related wellness initiative to help keep health costs down, while keeping employee productivity and retention up.

However the realities of promoting a healthy balance for employees, while simultaneously ensuring the delivery of quality work that’s completed on time, is much easier said than done. Anecdotally, we often hear that employees don’t feel they are benefiting from their corporate wellness plans because they don’t have time or they can’t break away from their desks.

Walk the walk
What can employers do to break the cycle? First and foremost, stress reduction starts from the top-down as management and bosses play a key role in employee adoption and lasting engagement. Not only are they responsible for communicating about available resources, they need to literally and figuratively walk the walk. When leadership incorporates stress management into their own lives, employees understand the company's commitment to these practices and feel more comfortable taking a break.

The role of technology
Some of the most effective wellness programs leverage a variety of technologies that offer something for everyone and makes it easier for employees to engage and benefit, regardless of where they are or the time of day. Popular technology-based solutions include:

· Digital health platforms — Connecting employees to health coaches, board-certified physicians, and colleagues who can provide support for those dealing with stress and offer guidance with chronic disease resulting from, or adding to, individuals’ stress levels.
· Digital health games — Employees receive encouragement and rewards through fun, engaging games in which they compete against others in stress-busting exercise to reach health goals.
· Wearables — Employees can sync popular wearable devices, such as their Apple Watch, to visualize the impact of guided meditations on their heart rate. Through smart feedback, employees can better understand which meditation exercises, locations, and times of day have the greatest impact on their heart rate, and therefore, stress level.
· Virtual Reality guided meditation — Combining an immersive VR with mindfulness meditation can help transport employees to relaxing environments, bringing a whole new dimension to the meditation experience. Using apps on their cell phones and portable VR headsets, employees are able to practice meditation from any place, at any time. In addition to stress reduction, a growing body of scientific evidence suggests that meditation can heighten attention spansimprove sleepreduce chronic pain and fight addictions like drug and alcohol abuse, and binge eating.

The bottom line: Stressed-out employees can have significant health and financial consequences for your clients. With the start of open enrollment season just a few short months away, it’s time to start educating your customers about the benefits of incorporating mental health programs, like digital health platforms and meditation, into their corporate wellness plans to mitigate employee stress and improve productivity.

Miller, M. (11 July 2018) "How tech solutions can take aim at employee stress" (Web Blog Post) Retrieved from https://www.employeebenefitadviser.com/opinion/mental-fitness-why-your-corporate-wellness-portfolio-needs-mental-health-solutions


Point-of-sale wellness: How health plans are cashing in

With skyrocketing healthcare costs, payers constantly look for ways to reduce costs and improve health. Continue reading to learn more.


Health care costs continue to skyrocket, and payers are constantly looking for ways to keep their populations healthier and to reduce these costs. Payers looking for more effective strategies to improve health and wellness for members should be aware of the new preventative approaches that more health plans are offering.

One such method that health plans are deploying to engage members is point-of-sale wellness, a type of incentive program that encourages members to actively make healthier purchases and lifestyle choices. As point-of-sale wellness becomes more prevalent among health plans, human resource managers and benefits brokers should understand how these programs work to best determine if they would be a valuable option for their employees and clients.

What is point-of-sale wellness?

Point-of-sale wellness is all about helping health plan members make smart, healthy purchasing decisions when they’re in a retail store or pharmacy. According to the Henry J. Kaiser Family Foundation, the average consumer visits their doctor 3.1 times per year. This same consumer will visit his or her favorite retailers multiple times per week. This presents the perfect opportunity for actionable engagement. It is often too easy for individuals to make impulsive decisions that favor cheaper care items or junk food that provides instant gratification but lead to an unhealthy lifestyle in the long run. Empowering consumers in these moments before checking out at the register with the understanding — and more importantly, the financial incentive — to make informed, smarter choices can lead to a healthier lifestyle and reduced health care costs. In short, the goal is to help individuals prioritize health and wellness at retail point of sale.

There are numerous ways that health plans can achieve this goal. One of the most common is by providing members with prepaid cards that are loaded with funds and discounts for the purchase of over-the-counter (OTC) items such as vitamins, diabetes care items and medications for allergies or cold and flu symptoms. The key component of these specialized prepaid cards is that they can be restricted-spend cards. In other words, they cannot be used to purchase any items that the health plan members want; they can only be used to purchase items off a curated list of products.

Under this arrangement, all parties, from the individual to the health plans and retailers, benefit. With a restricted-spend prepaid card in hand, an individual is rewarded for making purchases that contribute to a healthier lifestyle, while reducing health care costs both for themselves and the health plans administering the cards. In the meantime, the retailers partnering with the health plans to make point-of-sale wellness possible enjoy the opportunity to build long-term customer relationships with the health plan members using the cards.

Point-of-sale wellness in action

Point-of-sale wellness can be customized to be as general or specific as a health plan needs. For example, a health plan that supports a high number of new parents on a regular basis may offer a prepaid card designed specifically to assist members with newborn children. The first years of an infant’s life are among the most expensive from a health care perspective. More health plans are starting to offer new parents prepaid cards that are loaded with funds and discounts for items such as OTC medications, baby food and formula, diapers, strollers, car seats or thermometers. This opens an easier path for new parents to do basic at-home diagnostics and keep their babies’ health monitored so costly trips to an emergency room or urgent care center are not needed as often.

Payers that offer health and wellness programs to assist new parents in their populations can consider engaging health plans that offer these types of prepaid cards. Having a healthier child has the added benefit of reducing stress on the parents, which means they are in a better position to continue performing in the workplace.

Financial incentives for healthier choices

Most wellness programs are focused on informing participants of the best ways to support a healthier lifestyle, but that is only half of the equation. Point-of-sale wellness goes one step further to ensure participants are empowered from a financial perspective to make smarter purchasing decisions while shopping for daily care items. Businesses and benefits brokers who want to provide their employees and clients the best opportunities to live a healthier lifestyle should consider engaging health plans that prioritize these prepaid card incentives into their offerings.

Vielehr, D. (19 July 2018). "Point-of-sale wellness: How health plans are cashing in" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/07/19/point-of-sale-wellness-how-health-plans-are-cashin/


Improve workplace fitness by focusing on the collective "we"

Employees are more likely to try wellness programs if they know their coworkers are participating as well. In this article, Maurer discusses how focusing on the collective "we" will increase participation in employee wellness programs.


Workplace wellness programs are implicitly focused on the individual: biometric screenings, individual incentives, gym member reimbursements. This approach can leave employees feeling less than motivated to take part because, even though the programs focus is on the individual, by no means does it make the program personalized.

As workplace wellness programs rapidly improve to meet the expectations of today’s workers, it’s important to remember the value of accountability and what a culture of health can do to create a workplace committed to wellness solutions.

Since wellness programs have traditionally focused on the individual, oftentimes employees never know if their colleagues are participating in any of the programs being offered. Bring it into the light by giving your employees a program they want to talk about, while still keeping it personalized. The collective “we” are not only more likely to try a wellness program, but we are also more likely to stick with it, if we know our peers are also partaking.

The power of sharing with your peers

We all know writing down a goal gives you a much higher chance of achieving it, but research from the Association for Talent Development says someone is 65 percent more likely to achieve a goal if the goal is shared with another person. Why? Because it creates accountability.

We are in the day and age of a social media frenzy, and, it’s cross-generational. We share everything we do and spend a lot of our time concerned with what our friends, family and co-workers are doing through these social platforms. Wellness practitioners can and should be taking advantage of this, especially as you build your culture of health.

To find the right wellness solution for your company or client, look for solutions that are social and easy to use. If the company as a whole has buy-in, or even a few internal advocates, word-of-mouth can be incredibly powerful. Whether that is around the water-cooler at work, on employees’ personal social media channels, or within the work intranet, create opportunities for employees to talk about your program and encourage them to use it. We know when an employee knows a few of their coworkers are planning to attend yoga or kickboxing on a Tuesday evening, they are much more likely to sign up and actually go.

These “wellness relationships” help not only build stronger bonds at work, but they also help you create and maintain healthy habits. You want your employees to engage with your wellness solution, so encourage them to share and become part of the “solution” themselves. At the end of the day, workplace wellness solutions are there to help everyone get healthier and stay that way, but they have to use the program.

More than just an incentive

We have spent at least a decade looking at incentives and how we align them to solve problems with low participation in our wellness program, when we should have focused on building a program that empowers our employees and puts them in the driver’s seat. I’m not suggesting you stop incentivizing your employees, but I do suggest you measure what it is you are rewarding. If it can’t be measured you may as well burn the money you are investing.

Remember, your employees are the real reason your program will sink or swim. Take care of your employees and encourage them to be and find their healthiest selves. Empower them in the process and give them choice in how, when and with who they participate in your wellness program and let them become your wellness solution.

Maurer E. (18 July 2018). "Improving workplace wellness by focusing on the collective 'we'" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/07/18/improve-workplace-wellness-by-focusing-on-the-coll/.


A vacation can't undo the damage of a stressful work environment

Researchers say employees experience chronic stress during their workday and vacations aren't helping to fix it. Take a look at why a stress-free work environment is critical for productivity.


That easy breezy feeling after taking a vacation slips away pretty quickly when people have to face the same systemic workplace issues that wore them down in the first place, according to the American Psychological Association’s 2018 Work and Well-Being survey.

The Harris Poll surveyed 1,512 U.S. adults who were employed either full time, part time or were self-employed, and found that nearly a quarter (24 percent) say the positive effects of vacation time – such as more energy and feeling less stress – disappear immediately upon returning to work. Forty percent say the benefits last only a few days.

“Employers shouldn’t rely on the occasional vacation to offset a stressful work environment,” says David W. Ballard, head of APA’s Center for Organizational Excellence. “Unless they address the organizational factors causing stress and promote ongoing stress management efforts, the benefits of time off can be fleeting. When stress levels spike again shortly after employees return to work, that’s bad for workers and for business.”

More than a third (35 percent) of respondents say they experience chronic stress during their workday, due to low pay (49 percent), lack of opportunity for growth or advancement (46 percent), too heavy of a workload (42 percent) and unrealistic job expectations and long hours (39 percent each).

However, just half say their employer provides the resources necessary to help them meet their mental health needs. When adequate resources are provided, only 33 percent of the respondents say they typically feel tense or stressed out during the workday, compared to 59 percent of those who say their employer doesn’t provide sufficient mental health resources. When it comes to overall well-being, nearly three-fourths of employees supported with mental health resources (73 percent) say their employer helps them develop and maintain a healthy lifestyle, compared to 14 percent who say they don’t have the resources.

“Chronic work stress, insufficient mental health resources, feeling overworked and under supported – these are issues facing too many workers, but it doesn’t have to be this way,” Ballard says. “Psychological research points the way in how employers can adopt effective workplace practices that go a long way in helping their employees thrive and their business grow.”

Even in a very supportive workplace environment, encouraging vacations can boost morale and performance even more, according to the survey. Upon returning from vacation, employees who say their organization’s culture encourages time off were more likely to report having more motivation (71 percent) compared to employees who say their organization doesn’t encourage time off (45 percent). They are also more likely to say they are more productive (73 percent vs. 47 percent) and that their work quality is better (70 percent vs. 46 percent).

Overall, respondents are more likely to say they feel valued by their employer (80 percent vs. 37 percent), that they are satisfied with their job (88 percent vs. 50 percent) and that the organization treats them fairly (88 percent vs. 47 percent). They are similarly more likely to say they would recommend their organization as a good place to work (81 percent vs. 39 percent).

“A supportive culture and supervisor, the availability of adequate paid time off, effective work-life policies and practices, and psychological issues like trust and fairness all play a major role in how employees achieve maximum recharge,” Ballard says. “Much of that message comes from the top, but a culture that supports time off is woven throughout all aspects of the workplace.”

SOURCE:
Kuehner-Hebert, K (13 July 2018) "A vacation can't undo the damage of a stressful work environment" [Web Blog Post]. Retrieved from https://www.benefitspro.com/2018/07/02/a-vacation-cant-undo-the-damage-of-a-stressful-wor/


HRL - Woman - Frustrated

Addressing mental healthcare at work

Studies show that one in five adults has a mental health disorder. In this article, Olson list ways employers can address mental health within their organizations.


Nancy Spangler, senior consultant at the Center for Workplace Mental Health of the American Psychiatric Foundation, says that one in five adults has a mental health disorder, and one in 10 has a substance abuse problem. In addition, major depression and its associated conditions cost the U.S. over $210 billion every year. Clearly, mental health is an issue we need to investigate both in our offices and across the country.

Many organizations have found that simply by working with employees to recognize depression, build empathy, and find resources, increased EAP utilization while claim dollars did the opposite. In most cases there was no formal program involved—leadership simply began talking about the issue, and the reduced stigma led to better health (and better offices!).

What can we do besides reducing stigma, especially from the top down? At the 2018 Health Benefits and Leadership Conference, experts listed five “buckets” of challenges in addressing mental health: access to care, cost of care, stigma, quality, and integration. Breaking these down into individual components not only helps employees find the support they need and deserve, but it further reduces stigma by refusing to separate mental health from medical coverage or wellness programs. Experts also recommend inviting EAPs to visit offices in person, instead of simply suggesting employees call when they can. Another increasingly popular technique is text-based therapy. This a great fit for many employees because someone is always available and the conversation is always private, even when the client is sitting at a desk in a shared space.

In addition to reducing stigma through transparency and access, employers can also help increase the quality of care available to employees. One key move is simply asking for data. How do vendors evaluate quality, meet standards, and screen for illness? Do health plan members have confidential ways to report their experiences? Mental health care should be seen no differently from other kinds of health care. Employees who have access to quality, destigmatized mental health care build stronger, more functional, and ever-happier workplaces.

Olson B. (17 July 2018). "Addressing Mental Health Care at Work" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/addressing-mental-health-care-at-work.


Quality trumps convenience among employees

Convenience, or quality? Take a look into why researchers are saying quality of a doctors visit outshines convenience when scheduling the next appointment.


Faced with the choice between going to a conveniently located doctor’s office or a more qualified physician, group health plan members are four times more likely to embrace the better-perceived medical professional.

“Traditional metrics like patient ratings, prescribing rates and volume of patients seen were not nearly as compelling to respondents as more qualitative, contextualized statements about a doctor’s clinical expertise,” according to Nate Freese, senior director of data strategy at Grand Rounds, a healthcare service provider for employees in need of local and remote specialty care.

The data is based on a study of 1,100 members covered by Grand Rounds, which is headquartered in San Francisco.

While surprising, Freese says that result depends on the information and messaging that’s provided to employees. Just 14% of respondents based their choice on clinical expertise if they saw traditional physician profiles, whereas it was 69% if they saw contextualized profiles. Contextualized profiles offered more information in complete sentences compared to traditional profiles. These profiles also compared data against other doctors and specialists, such as appointment wait times, expertise and patient satisfaction.

Freese is encouraged by these findings, which were recently presented at the National Healthcare Ratings Summit. “Don’t sell employees short in terms of their ability to appreciate quality and willingness to sacrifice convenience,” he says.

Offering more subjective interpretation of hard quality metrics would be helpful, Freese explains, as long as employers and their advisers are careful not to “overstep what can be reasonably inferred based on available data.”

Another caveat to consider is that finding high quality providers may not be inherently more difficult in narrow networks. Rather, he says, the issue is when health plan members “lack the ability to identify them. And so, it’s more about presenting information in the right way.”

Providing compelling quality information can achieve the same results of a narrow network, he notes. But he hastens to add that even narrow networks must be sufficiently broad enough for members to have a reasonable amount of choice. Geography also plays a role. “You could be in the broadest network, but by virtue of where you live, have reduced choice,” he says.

Michael Hough, executive vice president and U.S. founder of Advance Medical, believes the quality metrics that are currently available are insufficient for several reasons. “We’re looking at things like frequency and whether the outcomes are horrible,” he says. “But just because the outcomes weren’t horrible doesn’t mean they were good, either.” Desired outcomes depend on what’s going on with patients and whether their objectives are being achieved.

The context of care is “extremely important,” Hough explains, noting the importance of relationships between the patient and a trained physician based on human interaction, as well as the delivery of services. Also, while he believes the rise of telemedicine and self-service “is good for many parts of our lives,” Hough cautions that it’s not necessarily true for healthcare because meaningful relationships trump convenience.

SOURCE:
Shutan, B (22 June 2018) "Quality trumps convenience among employees" [Web Blog Post]. Retrieved from https://www.employeebenefitadviser.com/news/quality-trumps-convenience-among-employees?tag=00000151-16d0-def7-a1db-97f0240f0000


Top 10 health conditions costing employers the most

Conditions that impact plan costs can be problematic. Here is a look into the top 10 health conditions hitting the hardest on employers wallets.


As healthcare costs continue to rise, more employers are looking at ways to target those costs. One step they are taking is looking at what health conditions are hitting their pocketbooks the hardest.

“About half of employers use disease management programs to help manage the costs of these very expensive chronic conditions,” says Julie Stich, associate vice president of content at the International Foundation of Employee Benefits Plans. “In addition, about three in five employers use health screenings and health risk assessments to help employees identify and monitor these conditions so that they can be managed more effectively. Early identification helps the employer and the employee.”

What conditions are costly for employers to cover? In IFEPB’s Workplace Wellness Trends 2017 Survey, more than 500 employers were asked to select the top three conditions impacting plan costs. The following 10 topped the list.

10. High-risk pregnancy

Although high-risk pregnancies have seen a dip of 1% since 2015, they still bottom out the list in 2017; 5.6% of employers report these costs are a leading cost concern for health plans.

9. Smoking

Smoking has remained a consistent concern of employers over the last several years; 8.6% of employers report smoking has significant impact on health plans.

8. High cholesterol

While high cholesterol still has a major impact on health costs- 11.6% say it's a top cause of raising healthcare costs- that number is significantly lower from where it was in 2015 (19.3%).

7. Depression/ mental illness

For 13.9% of employers, mental health has a big influence on healthcare costs. This is down from 22.8% in 2015.

6. Hypertension/ high blood pressure

This is the first condition in IFEBP's report to have dropped a ranking in the last two years. In 2015, hypertension/ high blood pressure ranked 5th with 28.9% of employers reporting it is a high cost condition. In 2017, the condition dropped to 6th with 27.6% of employers noting high costs associated with the disease.

5. Heart disease

This year's study found that 28.4% of employers reported high costs associated with heart disease. In 2015, heart disease was the second highest cost driver with 37.1% of employers citing high costs from the disease.

4. Arthritis/back/musculoskeletal

Nearly three in 10 employers (28.9%) say these conditions are drivers of their health plan costs, compared to 34.5% in 2015.

3. Obesity

Obesity is still a top concern for employers, but slightly less so than it was two years ago. In 2017, 29% of employers found obesity to be a burden on health plans. In 2015, 32.45 cited obesity as a major cost driver.

2. Cancer (all kinds)

Cancer has become more expensive for employers. Now, 35.4% of employers report cancer increasing the costs of health plans, compared to 32% in 2015.

1. Diabetes

The king of raising health costs, diabetes has topped the list both in 2015 and 2017. In the most recent report, 44.3% of employers say diabetes is among the conditions impacting plan costs.

SOURCE:
Otto. N (18 June 2018) "Top 10 health conditions costing employers the most" [Web Blog Post]. Retrieved from https://www.employeebenefitadviser.com/slideshow/top-10-health-conditions-costing-employers-the-most


7 wellness program ideas you may want to steal

Need more energy and excitement in your office? Keep your employees healthy and motivated with these fun wellness program ideas.


Building your own workplace wellness program takes work–and time–but it’s worth it.

“It’s an investment we need to make,” Jennifer Bartlett, HR director at Griffin Communication, told a group of benefits managers during a session at the Human Resource Executive Health and Benefits Leadership Conference. “We want [employees] to be healthy and happy, and if they’re healthy and happy they’ll be more productive.”

Bartlett shared her experiences building, and (continually) tweaking, a wellness program at her company–a multimedia company running TV outlets across Oklahoma –over the last seven years. “If there was a contest or challenge we’ve done it,” she said, noting there have been some failed ventures.

“We got into wellness because we wanted to reduce health costs, but that’s not why we do it today,” she said. “We do it today because employees like it and it increases morale and engagement.”

Though Griffin Communication's wellness program is extensive and covers more than this list, here are some components of it that's working out well that your company might want to steal:

  1. Fitbit challenge. Yes, fit bits can make a difference, Bartlett said. The way she implemented a program was to have a handful of goals and different levels as not everyone is at the same pace-some might walk 20,000 steps in a day, while someone else might strive for 5,000. There are also competition and rewards attached. At Griffin Communications, the company purchased a number of Fitbits, then sold them to its employees for half the cost.
  2. Race entry. Griffin tries to get its employees moving by being supportive of their fitness goals. If an employee wants to participate in a race-whether walking or running a 5k or even a marathon, it will reimburse them up to $50 one time.
  3. Wellness pantry. This idea, Bartlett said, was "more popular than I ever could have imagined." Bartlett stocks up the fridge and pantry in the company's kitchen with healthy food options. Employees then pay whole sale the price of the food, so it's a cheap option for them to instead of hitting the vending machine. "Employees can pay 25 cents for a bottled water or $1.50 for a soda from the machine."
  4. Gym membership. "We don't have an onsite workout facility, but we offer 50 percent reimbursement of (employees') gym membership cost up to a max of 200 per year," she said. The company also reimburses employees for fitness classes, such as yoga.
  5. Biggest Loser contest. Though this contest isn't always popular among companies, a Biggest Loser-type competition- in which employees compete to lose the most weight-worked out well at Griffin. Plus, Bartlett said, "this doesn't cost us anything because the employee buys in $10 to do it." She also insisted the company is sensitive to employees. For example, they only share percentages of weight loss instead of sharing how much each worker weights.
  6. "Project Zero" contest. This is a program pretty much everyone can use: Its aim is to avoid gaining the dreaded holiday wights. The contest runs from early to mid- November through the first of the year. "Participants will weigh in the first and last day of the contest," Bartlett said. "The goal is to not gain weight during the holidays-we're not trying to get people to lose weight but we're just to not get them to not eat that third piece of pie."
  7. Corporate challenges. Nothing both builds camaraderie and encourages fitness like a team sports or company field day. Bartlett said that employees have basically taken this idea and run with it themselves- coming up with fun ideas throughout the year.

SOURCE:
Mayer K (14 June 2018) "7 wellness program ideas you may want to steal" [Web Blog Post]. Retrieved from https://www.benefitspro.com/2015/10/10/7-wellness-program-ideas-you-may-want-to-steal/


Lack Of Insurance Exposes Blind Spots In Vision Care

Vision problems are typically not life threatening but can impact the success of your everyday life. Vision care is a significant benefit that could change the lives of many families.


Every day, a school bus drops off as many as 45 children at a community eye clinic on Chicago’s South Side. Many of them are referred to the clinic after failing vision screenings at their public schools.

Clinicians and students from the Illinois College of Optometry give the children comprehensive eye exams, which feature refraction tests to determine a correct prescription for eyeglasses and dilation of their pupils to examine their eyes, including the optic nerve and retina.

No family pays out-of-pocket for the exam. The program bills insurance if the children have coverage, but about a third are uninsured. Operated in partnership with Chicago public schools, the program annually serves up to 7,000 children from birth through high school.

“Many of the kids we’re serving fall through the cracks,” said Dr. Sandra Block, a professor of optometry at the Illinois College of Optometry and medical director of the school-based vision clinics program. Many are low-income Hispanic and African-American children whose parents may not speak English or are immigrants who are not in the country legally.

Falling through the cracks is not an uncommon problem when it comes to vision care. According to a 2016 report from the National Academies of Sciences, Engineering and Medicine, as many as 16 million people in the United States have undiagnosed or uncorrected “refractive” errors that could be fixed with eyeglasses, contact lenses or surgery. And while insurance coverage for eye exams and corrective lenses clearly has improved, significant gaps remain.

The national academies’ report noted that impaired vision affects how people experience their world, including normal communication and social activities, independence and mobility. Not seeing clearly can hamper children’s academic achievement, social development and long-term health.

But when people must choose, vision care may lose out to more pressing medical concerns, said Block, who was on the committee that developed the report.

“Vision issues are not life-threatening,” she said. “People get through their day knowing they can’t see as well as they’d like.”

Insurance can make regular eye exams, glasses and treatment for medical problems such as cataracts more accessible and affordable. But comprehensive vision coverage is often achieved only through a patchwork of plans.

The Medicare program that provides coverage for millions of Americans age 65 and older doesn’t include routine eye exams, refraction testing or eyeglasses. Some tests are covered if you’re at high risk for a condition such as glaucoma, for example. And if you develop a vision-related medical condition such as cataracts, the program will cover your medical care.

But if you’re just a normal 70-year-old and you want to get your eyes examined, the program won’t cover it, said Dr. David Glasser, an ophthalmologist in Columbia, Md., who is a clinical spokesman for the American Academy of Ophthalmology. If you make an appointment because you’re experiencing troubling symptoms and get measured for eyeglasses while there, you’ll likely be charged anywhere from about $30 to $75, Glasser said.

There are a few exceptions. Medicare will pay for one pair of glasses or contact lenses following cataract surgery, for example. Some Medicare Advantage plans offer vision care.

Many commercial health insurance plans also exclude routine vision care from their coverage. Employers may offer workers a separate vision plan to fill in the gaps.

VSP Vision Care provides vision care plans to 60,000 employers and other clients, said Kate Renwick-Espinosa, the organization’s president. A typical plan provides coverage for a comprehensive eye exam once a year and an allowance toward standard eyeglasses or contact lenses, sometimes with a copayment. Also, individuals seeking plans make up a growing part of their business, she said.

Vision coverage for kids improved under the Affordable Care Act. The law requires most plans sold on the individual and small-group market to offer vision benefits for children younger than 19. That generally means that those plans cover a comprehensive eye exam, including refraction, every year, as well as a pair of glasses or contact lenses.

But since pediatric eye exams aren’t considered preventive care that must be covered without charging people anything out-of-pocket under the ACA, they’re subject to copays and the deductible.

Medicaid programs for low-income people also typically cover vision benefits for children and sometimes for adults as well, said Dr. Christopher Quinn, president of the American Optometric Association, a professional group.

But coverage alone isn’t enough. To bring down the number of people with undiagnosed or uncorrected vision, education is key to helping people understand the importance of eye health in maintaining good vision. Just as important, it can also reduce the impact of chronic conditions such as diabetes, the national academies’ report found.

“All health care providers need to at least ask vision questions when providing primary care,” said Block.

SOURCE:
Andrews M (13 JUNE 2018). "Lack Of Insurance Exposes Blind Spots In Vision Care" [Web Blog Post]. Retrieved from https://khn.org/news/lack-of-insurance-exposes-blind-spots-in-vision-care/


Are You And Your Primary Care Doc Ready To Talk About Your DNA?

Knowing your genes could save your life, especially if a genetic mutation is hereditary. See why incorporating DNA testing is a crucial part of your primary care.


If you have a genetic mutation that increases your risk for a treatable medical condition, would you want to know? For many people the answer is yes. But such information is not commonly part of routine primary care.

For patients at Geisinger Health System, that could soon change. Starting in the next month or so, the Pennsylvania-based system will offer DNA sequencing to 1,000 patients, with the goal to eventually extend the offer to all 3 million Geisinger patients.

The test will look for mutations in at least 77 genes that are associated with dozens of medical conditions ranging from heart disease to cancer, as well as variability in how people respond to pharmaceuticals based on heredity.

“We’re giving more precision to the very important decisions that people need to make,” said Dr. David Feinberg, Geisinger’s president and CEO. In the same way that primary care providers currently suggest checking someone’s cholesterol, “we would have that discussion with patients,” he said. “‘It looks like we haven’t done your genome. Why don’t we do that?’”

Some physicians and health policy analysts question whether such genetic information is necessary to provide good primary care — or feasible for many primary care physicians.

The new clinical program builds on a research biobank and genome-sequencing initiative called MyCode that Geisinger started in 2007 to collect and analyze its patients’ DNA. That effort has enrolled more than 200,000 people.

Like MyCode, the new clinical program is based on whole “exome” sequencing, analyzing the roughly 1 percent of the genome that provides instructions for making proteins, where most known disease-causing mutations occur.

Using this analysis, clinicians might be able to tell Geisinger patients that they have a genetic variant associated with Lynch syndrome, for example, which leads to increased risk of colon and other cancers, or familial hypercholesterolemia, which can result in high cholesterol levels and heart disease at a young age. Some people might learn they have increased susceptibility to  malignant hyperthermia, a hereditary mutation that can be fatal since it causes a severe reaction to certain medications used during anesthesia.

Samples of a patient’s blood or spit are used to provide a DNA sample. After analysis, the results are sent to the patient’s primary care doctor.

Before speaking with the patient, the doctor takes a 30-minute online continuing education tutorial to review details about genetic testing and the disorder. Then the patient is informed and invited to meet with the primary care provider, along with a genetic counselor if desired. At that point, doctor and patient can discuss treatment and prevention options, including lifestyle changes like diet and exercise that can reduce the risk of disease.

About 3.5 percent of the people who’ve been tested through Geisinger’s research program had a genetic variant that could result in a medical problem for which clinicians can recommend steps to influence their health, Feinberg said. Only actionable mutations are communicated to patients. Geisinger won’t inform them if they have a variant of the APOE gene that increases their risk for Alzheimer’s disease, for example, because there’s no clinical treatment. (Geisinger is working toward developing a policy for how to handle these results if patients ask for them.)

Wendy Wilson, a Geisinger spokeswoman, said that what they’re doing is very different from direct-to-consumer services like 23andMe, which tests customers’ saliva to determine their genetic risk for several diseases and traits and makes the results available in an online report.

“Geisinger is prescribing DNA sequencing to patients and putting DNA results in electronic health records and actually creating an action plan to prevent that predisposition from occurring. We are preventing disease from happening,” she said.

Geisinger will absorb the estimated $300 to $500 cost of the sequencing test. Insurance companies typically don’t cover DNA sequencing and limit coverage for adult genetic tests for specific mutations, such as those related to the breast cancer susceptibility genes BRCA1 or BRCA2, unless the patient has a family history of the condition or other indications they’re at high risk.

“Most of the medical spending in America is done after people have gotten sick,” said Feinberg. “We think this will decrease spending on a lot of care.”

Some clinicians aren’t so sure. Dr. H. Gilbert Welch is a professor at the Dartmouth Institute for Health Policy and Clinical Practice who has authored books about overdiagnosis and overscreening, including “Less Medicine, More Health.”

He credited Geisinger with carefully targeting the genes in which it looks for actionable mutations instead of taking an all-encompassing approach. He acknowledged that for some conditions, like Lynch syndrome, people with genetic mutations would benefit from being followed closely. But he questioned the value of DNA sequencing to identify other conditions, such as some related to heart disease.

“What are we really going to do differently for those patients?” he asked. “We should all be concerned about heart disease. We should all exercise, we should eat real food.”

Welch said he was also concerned about the cascading effect of expensive and potentially harmful medical treatment when a genetic risk is identified.

“Doctors will feel the pressure to do something: start a medication, order a test, make a referral. You have to be careful. Bad things happen,” he said.

Other clinicians question primary care physicians’ comfort with and time for incorporating DNA sequencing into their practices.

A survey of nearly 500 primary care providers in the New York City area published in Health Affairs this month found that only a third of them had ordered a genetic test, given patients a genetic test result or referred one for genetic counseling in the past year.

Only a quarter of survey respondents said they felt prepared to work with patients who had genetic testing for common diseases or were at high risk for genetic conditions. Just 14 percent reported they were confident they could interpret genetic test results.

“Even though they had training, they felt unprepared to incorporate genomics into their practice,” said Dr. Carol Horowitz, a professor at the Icahn School of Medicine at Mount Sinai in New York, who co-authored the study.

Speaking as a busy primary care practitioner, she questioned the feasibility of adding genomic medicine to regular visits.

“Geisinger is a very well-resourced health system and they’ve made a decision to incorporate that into their practices,” she said. In Harlem, where Horowitz works as an internist, it could be a daunting challenge. “Our plates are already overflowing, and now you’re going to dump a lot more on our plate.”

SOURCE:
Andrews, M (12 June 2018). "Are You And Your Primary Care Doc Ready To Talk About Your DNA?" [Web Blog Post]. Retrieved from https://khn.org/news/are-you-and-your-primary-care-doc-ready-to-talk-about-your-dna/