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Enhancing Diabetes Care: A Payer's Perspective on Bridging Gaps and Improving Outcomes

Leveraging AI for Improved Outcomes and Cost-Efficient Diabetes Care

In the ever-changing landscape of healthcare, payers play a crucial role in shaping the quality, efficiency, and accessibility of services. In the context of diabetes care, the significance of diabetic retinopathy screenings cannot be overstated. Diabetic retinopathy stands as the leading cause of vision loss in working-age adults in the US. Given the challenge of low adherence rates to screenings, there is a pressing need for diabetic eye exams that are both accessible and convenient, benefiting patients, providers, and payers alike. AI-based diabetic retinopathy screening solutions enable primary care providers to screen patients in their clinic instead of referring to specialists, and as a result address the problem of low adherence to required annual screenings.

AI-based DR screening solutions enable any primary care provider - a nurse, physician assistant, medical assistant - to perform the procedure. There is no need for any special training as the AI is responsible for “interpreting” the images and determining whether there are signs of referrable DR or not. The procedure itself is short, requiring the provider to obtain two images per eye using a fully automated retinal camera. Some solutions require only one image per eye, making the procedure even simpler and shorter. Once the images are sent to the AI for analysis, a result is returned in a matter of seconds.

So while primary care providers are overworked and understaffed, AI-based DR screening is a short and simple enough procedure that they can squeeze into their already tight patient visits. They can also perform the procedure as part of a clinical support visit. And with reasonable reimbursement for the procedure using dedicated CPT code 92229, primary care providers can cover their costs and close care gaps.

Early detection through diabetic retinopathy screenings in primary care not only contributes to improved patient outcomes but also proves to be more cost-effective in the long run. The economic burden of blindness resulting from diabetic retinopathy is substantial, including the costs associated with specialized care, rehabilitation, and potential loss of productivity. Investing in AI-driven diagnostic screenings within primary care settings is a proactive measure that aligns with the principle that prevention is more economical than intervention. Detecting and managing diabetic retinopathy at an early stage not only prevents the progression of the disease but also minimizes the financial strain on the healthcare system. Payers, by championing the integration of these transformative technologies, actively participate in a strategy that not only enhances patient care but also contributes to substantial cost savings.

Minimizing Barriers to Care

Specialist referrals often present obstacles to accessing timely healthcare. With only 15-50% of patients adhering to their annual diabetic retinopathy screenings, addressing this significant care gap is imperative. AEYE-DS, with its rapid 2-minute eye exam capability, eliminates the need to refer patients to eye care specialists to have their annual screening done. Patients can undergo screenings in the convenience of their point of care, while waiting to see their physician, and immediately discussing results and care plan as needed. This proves particularly beneficial for patients in remote or underserved areas, addressing healthcare disparities and promoting equitable access to preventive services.

Cost-Efficiency Through Targeted Referrals

Payers, perpetually focused on optimizing costs while maintaining care quality, can greatly benefit from screening patients in primary care. The procedure has a dedicated CPT code 92229 which is cheaper than a visit to the ophthalmologist and addresses the care gap in a very targeted manner. Additionally it helps close care gaps, which in turn improve HEDIS scores and Star Ratings.

Closing the Adherence Gap

The low adherence to recommended diabetic eye exams poses a significant challenge to effective diabetes management. AEYE-DS addresses this adherence gap by providing an accessible and convenient screening option within the primary care setting. The 2-minute exam, with on the spot diagnosis encourages more individuals to adhere to their regular diabetic eye exams, contributing to better long-term health outcomes.

Automated Integration: Efficiency in Reporting and Claims Processing

The integration of AEYE-DS into Electronic Medical Records (EMRs) is a game-changer for payers. This automated system streamlines the reporting and claims processing associated with diabetic retinopathy screenings. Payers can ensure accurate documentation of these screenings, facilitating efficient data management and reporting. The seamless integration not only enhances operational efficiency but also positions payers as advocates for advanced, data-driven healthcare solutions.

Improving Member Satisfaction

Member satisfaction is a key metric for payers, and the promotion of diabetic retinopathy screenings in primary care is a step toward enhancing this aspect. By making preventive screenings more accessible and efficient, payers contribute to a positive healthcare experience for their members. This not only improves patient satisfaction but also reflects positively on the payer's commitment to proactive healthcare management.

Advocating for Change

In conclusion, the adoption of diabetic retinopathy screenings in primary care, facilitated by innovative solutions like AEYE-DS, is not merely a technological advancement but a strategic move toward comprehensive and patient-centered diabetes care. Payers play a pivotal role in advocating for the integration of such solutions into primary care settings, aligning with the broader goals of improving patient outcomes, minimizing costs, and fostering a healthcare system that prioritizes accessibility and efficiency. As we look toward the future, the promotion of diabetic retinopathy screenings in primary care stands as a testament to the commitment of payers to the well-being of their members and the advancement of preventive healthcare.

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