How Routine Eye Care Can Save Both Health Plans & Their Members in 2022 

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Male doctor ophthalmologist is checking eye vision of beautiful young woman in modern clinic. Doctor and patient in ophthalmology clinic.

Cool Photos from Depositphotos

By Mark Ruchman, MD

In the United States alone, 34.2 million adults have diabetes – a staggering 10.5% of the population. As most health plan leaders know, members with diabetes are also at high risk for a number of other health complications, one of which is diabetic retinopathy.

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Diabetic retinopathy is a serious and sight-threatening complication of diabetes. At first, diabetic retinopathy may cause mild or even no symptoms at all; however, over time it can cause blindness. For both members and health plans, the disease can also be exceptionally costly. According to the Centers for Disease Control and Prevention diabetes-related blindness costs can total more than $500 million per year. 

Diabetes, related vision impairment and the associated costs affect all age groups, demographics and, thus, health plans. For this reason, it’s critical that health plans and their partners understand how best to identify, educate and positively impact at-risk members. 

Reaching High-Risk Members  

Plan members with diabetes, 30% of which suffer from diabetic retinopathy, should understand both what diabetic retinopathy is and that they are at a higher risk for developing the disease. That said, those currently living with diabetes are not the only ones at higher risk. Other high-risk populations include Hispanic and African American people; individuals with medical conditions, such as high blood pressure and high cholesterol; pregnant women, especially if they develop gestational diabetes; and those with a family history of diabetic retinopathy.

Identifying all members at high-risk of developing diabetic retinopathy must be a both reactive and proactive process by health plans—and their vision wellness partners. For example, to pinpoint the plan members who may require more intensive oversight and early intervention, advanced health plan vision partners may reactively ask eye care professionals in their networks specific questions regarding retinopathy claims. From there, those vision partners are able to use predictive analytics to proactively detect diabetes and diabetic retinopathy—lessening the time and costs it may take to treat disease by intervening before advanced stages.

Being attentive to the needs of these patients on their health care journeys is crucial to their overall health and can mean big savings for members and health plans alike. 

Preaching Preventive 

Many health plan members use the new year as a way to adjust their wellness routines, working to uphold promises of more gym trips, earlier wake times and fewer sweets. And while these goals are certainly helpful in maintaining whole body health, many lose sight of the preventive measures they can be taking to address these same needs. 

It’s essential that all plan members, regardless of diabetic retinopathy risk level, know that simply booking and attending regular routine eye care appointments is one of the most effective ways to avoid costly and complex visual impairment. 

Community outreach programs by innovative vision care partners, overseen by healthcare experts, work to ensure annual eye exams are completed, particularly by those plan members who may not have traditional access to routine care. In doing so, the quality measure (DRE) for diabetics is improved, which in turn helps health plans increase their overall HEDIS and Star measures. 

Conducting the analysis and outreach necessary for early intervention and management of diabetic retinopathy can feel overwhelming, but it’s hugely important in the overall health of plan members. Health plans may benefit from working with an eye health organization specifically equipped to face these issues head on. For many of their members, it could be the difference between blindness and sight, the difference between overwhelming costs and financial health.

Mark Ruchman, MD, is the chief medical officer at Versant Health. Dr. Ruchman provides all medical and clinical oversight, which includes quality improvement, clinical guidelines and accreditation standards.

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