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    Total Eye

    Value-Based Eye Care. Measurable Plan Performance.

    Total Eye applies a value-based approach across Routine Vision and Medical & Surgical Eye Care to improve quality, align providers, and deliver up to 30% savings.

    Eye Care is a Major Specialty Cost Driver

    Eye care is a major specialty cost driver in Medicare populations, spanning routine vision, high-volume procedures, retinal drug spend, and emerging treatments with significant future cost implications.

    As utilization, site-of-service variation, and specialty drug innovation continue to shape total cost of care, health plans benefit from a coordinated model that brings greater visibility, alignment, and management discipline across the eye care continuum. 

    #2 CMS-Paid Specialty

    Eye care represents one of the largest CMS-paid specialty categories. Over $4B in annual Medicare Part B spend is on anti‑VEGF eye injectables alone. 

    Cataract Surgery Demand

    Up to 70% of Medicare beneficiaries will require cataract surgery—the highest‑volume surgical procedure in Medicare. 

    Site-of-Service Variation

    Up to 30% of eye care procedures occur in hospital outpatient departments, which cost 40–60% more than ambulatory surgery centers for the same procedure. 

    A Pipeline of Costly Treatments

    Emerging wet AMD gene therapies are projected to cost almost $1M, making retinal drug management an increasingly important part of eye care strategy. 

    Our Value-Based Eye Care Model

    The Right Providers. Aligned Incentives. Clinical Oversight. Better Outcomes.

    Total Eye delivers up to 30% savings through a value-based model built on three integrated capabilities: curated provider networks, specialty drug management, and clinical oversight. Together, these capabilities help align providers, guide care to high-value settings, manage specialty drug spend, and improve performance across the eye care continuum.

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    Curated Value-Based Networks​

    Community-based ophthalmologists, ambulatory surgery centers, and aligned reimbursement models support high-quality, cost-effective care across the eye care continuum.

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    Specialty Drug Management

    Evidence-based treatment pathways, clinical oversight, and provider engagement help manage spend on high-cost ocular injectables while supporting appropriate utilization and quality outcomes.

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    Clinical Oversight

    Clinical protocols, utilization management, and ongoing performance monitoring support consistent care delivery and help guide members to the most appropriate provider and setting.

    Better Together. Flexible by Design.

    Total Eye manages eye care as a connected ecosystem, bringing Routine Vision and Medical & Surgical Eye Care together under one coordinated strategy. Routine Vision supports preventive care, quality performance, and early identification of disease. Medical & Surgical Eye Care provides oversight for treatment pathways, procedures, specialty drugs, and complex eye conditions.

    Together, these programs help health plans create greater visibility, stronger provider alignment, and more effective management across the eye care journey.

     

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    ROUTINE VISION

    Preventive eye care with quality performance built-in

    Routine Vision focuses on annual eye exams, refractions, and eyewear access. It supports early identification of eye disease and closes diabetic eye exam care gaps through structured quality programs.

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    MEDICAL & SURGICAL EYE CARE

    Clinical oversight for medical and surgical eye services

    Medical & Surgical Eye Care manages the diagnosis and treatment of eye disease, including medical visits, ophthalmic drugs, and surgery. The program applies clinical protocols and utilization oversight to manage high-cost services and guide members to appropriate care.

    Our Excellence is Your Edge

    Total Eye combines clinical expertise, provider engagement, quality strategies, and specialty management capabilities to help health plans perform better and manage eye care more effectively. 

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    Earlier Disease Identification

    Routine eye exams support preventive care and help identify conditions earlier in the care journey.

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    Quality Performance Support

    Programs focused on diabetic eye exams, provider engagement, and care gap closure support quality improvement initiatives.

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    Care Navigation

    Members are connected with the most appropriate provider and care setting based on clinical need.

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    Provider Alignment

    Clinical programs and performance strategies help align providers around quality and value.

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    Medical & Surgical Oversight

    Clinical oversight supports evidence-based management of complex eye conditions and procedures.

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    Specialty Drug Management

    Treatment pathways help guide retinal care band emerging drugs that influence future eye care costs.

    Let's Make a Mark in Specialty Management

    Eye care continues to play an increasingly important role in quality performance, specialty utilization, and healthcare spend. Total Eye helps health plans connect clinical excellence, provider alignment, and cost management through a coordinated specialty management strategy.

    Download Total Eye Overview