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Preventing Diabetic Blindness: An Innovative Solution for Primary Care

Web Page from Intelligent Retinal Imaging Systems (IRIS)

30 million people in the United States have diabetes. Diabetes and its effects can be devastating to the patient, and costly to treat. In fact, in 2012 the direct medical cost of treating diabetes in the United States was $176 billion.

Diabetes is the leading cause of adult-onset blindness, however more than 95 percent of vision loss is preventable thanks to modern therapies. One of the most effective therapies is called a diabetic retinopathy exam (DRE). Through this exam, it is possible to diagnose retinal pathologies in patients with diabetes, including blindness.

CoxHealth serves a population of over 24,000 patients with diabetes. Included on Missouri’s “Best Hospitals” list by U.S. News & World Report, CoxHealth is Missouri’s only locally-owned, not-for-profit health system, operating five hospitals and more than 80 physician clinics.

For CoxHealth, the challenge was getting their patients to follow through on referrals to ophthalmologists for their annual exams. Generally speaking, only about 50 percent of at-risk diabetic patients undergo retinal evaluation. CoxHealth’s compliance rate for DRE screenings was just 32%.

Undiagnosed pathologies were putting patients at risk for blindness, impeding preventative and interventional care to this specific patient population. The cost of retinal drug therapy is now the second most expensive pharmaceutical drug group behind cancer treatments. Early detection results in early treatment with less expensive therapies.

Financially, CoxHealth was hurt by not attaining Healthcare Effectiveness Data and Information Set (HEDIS) quality scores, which are determined by achieving certain consensus quality measures, including DRE. HEDIS is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service, and are important to determining rates of fee-for-service reimbursements. Low performance on DRE measures is common among primary care medical groups, and often a reason organizations fail to achieve 5 STAR quality outcomes. For CoxHealth, a HEDIS STAR rating of 2 was impacting the amount of enhanced revenue that was falling to its bottom line.  

DRE is a high ROI service because it allows for payments to primary care for telemedicine and prevention in the form of a fee-for-service reimbursement and adjusted Risk Adjustment Factor (RAF) payments for at-risk populations. The optimum ROI can only be reached if quality metrics are achieved. For CoxHealth this care gap created a barrier to raising HEDIS and Hierarchical Condition Categories (HCC)/ RAF scores.

To address this care gap and help raise its scores, CoxHealth wanted to enable the DRE to be performed by its primary care providers, allowing patients with diabetes to receive the exam during each regular visit. They needed a solution that was easy to use, standardized workflows, and automation to ensure success.

CoxHealth needed an end-to-end solution that would identify the patients without exams, provide an eye exam with diagnostic capabilities, and activate referral, billing and reimbursement.  A programmatic approach, supported by a bidirectional Cerner EHR interface, was the only way for them to drive their desired results. They partnered with Intelligent Retinal Imaging Systems (IRIS) to implement this type of program.

The IRIS retinal telemedicine platform was developed to help end preventable, permanent blindness caused by diabetic retinopathy. The IRIS platform simultaneously improves quality, increases access and reduces cost of care.

The IRIS team works closely with each organization, creating workflows, documenting the processes, and installing best practices that have been developed from working with more than 125 health systems. The organization selects the high definition camera that works best for their environment. IRIS provisions it and provides end-to-end service—everything from image transmission to expert interpretation, report and recommendation.

Any staff member can administer the automated exam process and the findings and referral recommendations are transmitted back to the originating primary care physician, and directly into the EHR within hours. From there, the data is generated for the referral and billing.
Since CoxHealth’s implementation, HEDIS compliance rates are steadily increasing across multiple payer contracts with one key contract near 80%. CoxHealth is also improving its HCC/RAF scores in risk-based contracts, which recognizes increased payments from its payers to care for their members.

The true measure of success is ensuring patients with diabetes are properly diagnosed and receive the appropriate treatment to save their vision. CoxHealth’s implementation of the IRIS solution enables physicians to do what they do best – provide outstanding care to their patients.

By partnering together, IRIS and CoxHealth are saving sight and changing the lives of thousands by providing diabetic retinopathy exams in primary care facilities.

Web Page from Intelligent Retinal Imaging Systems (IRIS)