Biography/Disclosures
Biography:

Edmonds is a senior medical advisor and chief eye care officer at United Healthcare, co-director of the Low Vision/Contact Lens Service at Wills Eye Hospital in Philadelphia and a member of the PCON Editorial Board.

December 30, 2019
2 min read
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BLOG: Aligning your wellness resources for primary care

Biography/Disclosures
Biography:

Edmonds is a senior medical advisor and chief eye care officer at United Healthcare, co-director of the Low Vision/Contact Lens Service at Wills Eye Hospital in Philadelphia and a member of the PCON Editorial Board.

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With the year winding down, many of us are reviewing the numbers for 2019, looking for Section 179 purchase items for this tax year and planning for the new year of the optometrist, 2020.

If your practice is like mine, you may have noted that the biggest area of revenue growth in 2019 has been in medical care and wellness care. Unlike medical and vision care, patients are not only willing, but often eager to pay out of pocket for wellness-based products and services.

Wellness service are not just a line item, however. When properly deployed they are the foundation of primary medical care.

Some wellness services such as widefield retinal imaging and OCT are universal or a good idea for everyone. There is an expanding body of evidence indicating that wellness screening with noninvasive retinal scans can reveal risk or even frank evidence of systemic pathology. This involves well-known vascular problems such as diabetes, hypertension and dyslipidemia, and the newer evidence now includes Alzheimer’s disease and a host of other neurologic problems (Doustar et al.).

Other wellness strategies are more targeted and should be deployed based on risk factors uncovered in the comprehensive eye examination. These factors include family history, social habits, vital signs and the results of the physical eye examination. Risk tools are available and should be used to recommend lifestyle changes, supplements, exercise programs or formal wellness counseling. The American Diabetes Association has a great online tool to help you guide your patients with risk factors in this area. Likewise, the American Heart Association has a downloadable risk calculator that is available to help you manage cardiovascular risks for your patients.

Your office might like to offer supplements to help manage certain risk factors. This is a logical expansion to the supplements that you may already offer for dry eye or age-related macular degeneration. As with these disorders, the correct recommendation is risk based. You may also want to offer fitness trackers or other wearable technology. Some of these trackers and monitors are spectacle based and may be integrated with Rx lenses. There are also contact lenses that can monitor IOP for glaucoma patients. Other contact lenses are in development to monitor blood sugar and may also become part of the optometric management of insulin resistance and diabetes.

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As we move deeper into the wellness industry – and, by the way, this is a $4.2 trillion industry – we should consider moving past just dabbling with a couple jars of vitamins and a scan or two. Partnering with a formal wellness program and referring your patients with specific risk factors, as determined by your comprehensive exam, is the path to developing a primary care practice. These programs can be exercise- and nutrition-based for obesity or counseling- and advice-based for smoking, substance abuse or mental health problems. On the other hand, you might consider a comprehensive program that features functional medicine or seeks to look for the root cause of disease or dysfunction.

In reviewing candidates for a wellness partner, I have found some who are very interested in optometry, as our eye examination (Lewis) as well as some of our noninvasive scans are very helpful in accessing overall health risk factors (Doustar et al.).

Health care reform is not only happening with a series of new laws, including the Affordable Care Act. It is also happening with initiatives, pilots and projects by health plans as well as care delivery trends and the addition of new technologies at the practice level. Optometry’s transition to primary medical care with an emphasis on prevention, wellness and patient education is a shining example of health care reform and an important part of creating a healthier nation.

References:

Doustar J, et al. Front Neurol. 2017;doi:10.3389/fneur.2017.00701.

Lewis TJ. Cataracts – A sign of a deeper problem. Health Revival Partners. Posted October 21, 2019. Accessed December 27, 2019.