Why health plan members should add routine eye care to their holiday checklists

‘Tis the holiday shopping season—and in addition to gifts for loved ones, many health plan members will look to check end-of-year items off their lists, like spending the remainder of their FSA. While they’re thinking about their end-of-year to dos—and looking forward toward making their 2022 New Year’s Resolutions—health plan partners should be connecting with their members about the benefits of routine eye care.

While routine eye care sounds simple in nature, it can lead to major health discoveries that can allow for early diagnoses and cost savings for both plans and their members. Specifically, diabetic retinopathy is currently the leading cause of blindness in American adults—yet, the American Diabetes Association estimates that more than seven million people aren’t even aware that they have this debilitating disease, which can be diagnosed during a routine eye exam.

In understanding the below, health plans and their partners can help set plan members on the right path—and witness significant cost savings—while it is top of mind, before the end of the year… and before serious eye disease strikes:

What is diabetic retinopathy/? What are the signs? What members are most at risk?

Diabetic retinopathy is a serious sight-threatening complication of diabetes. The condition causes progressive damage to the retina, the light-sensitive lining at the back of the eye. Over time, it can also cause blindness.

At first, diabetic retinopathy can have little-to-no warning signs. However, as the condition progresses, one might experience blurred vision, loss of peripheral vision, dark spots in vision, difficulty seeing well at night, impaired color vision or seeing spots or floaters.

There are risk factors that can increase a member’s chance of developing diabetic retinopathy. Individuals with diabetes are of course at risk, with those having had diabetes longer at higher risk. However, there are other factors at play, including:

• Race: Hispanic and African American people have a higher risk of developing diabetic retinopathy.
• Medical conditions: Individuals with medical conditions such as high blood pressure and high cholesterol are at greater risk for developing diabetic retinopathy.
• Pregnancy: Pregnant women are at an increased risk of developing diabetes and diabetic retinopathy. If a woman develops gestational diabetes, she has a higher risk of developing diabetes as she ages.
• Family history: Individuals with a family history of diabetes are at higher risk of developing diabetic retinopathy.

Is diabetic retinopathy costly to plan members? To health plans?

For health plans and members alike, diabetic retinopathy can be incredibly costly. In fact, the Centers for Disease Control and Prevention found that diabetes-related blindness costs can total more than $500 million per year.

According to a study from the National Library of Medicine, nearly 30 percent of diabetics suffer from diabetic retinopathy—and those with this condition have noticeably higher medical costs than those with other diabetes-related conditions. For members on Medicare, average annual Medicare payments for all care—not just ophthalmic care—are higher for patients with diabetic retinopathy.

Is there anything health plans and their partners can do to help members prevent diabetic retinopathy and the financial repercussions that come along with it?

Fortunately, diabetic retinopathy happens to be one of the most preventable causes of visual impairment. Regular vision screenings and eye exams are simple—but critical—for spotting and treating diabetic retinopathy before irreversible damage is done. In fact, an annual diabetic retinal exam is the least expensive and most impactful method of tracking the progression of diabetes.

However, there are other methods for helping prevent systemic disease and reducing healthcare costs for both health plans and members. For example, at Versant Health, we ask eye care professionals questions specific to retinopathy when claims are made in order to help identify patients who may be at risk and/or require more intensive oversight. In fact, for those with comprehensive vision care through Versant Health’s plans, we are able to review claims to use predictive analytics to proactively detect diabetes and/or diabetic retinopathy.

Sophisticated community outreach programs are also impactful—overseen by our healthcare experts, Versant Health’s goal is to reduce blindness due to diabetic eye disease. By ensuring annual eye exams are completed, the quality measure (DRE) for diabetics is improved, which helps health plans increase their overall HEDIS and Star measures.

Diabetic retinopathy affects—and costs—millions. In taking the time to ensure monitoring and outreach efforts to health plan members, particularly those who are at high risk of developing this potentially debilitating disease, are in place, health plans and their members will benefit greatly.

Mark Ruchman is chief medical officer at Versant Health.