Optometrists Moving Diabetics to Treatment
As noted by the Joint State Government Commission, a non-partisan, bicameral research arm of the Pennsylvania General Assembly, “Diabetes remains a serious and growing public health problem causing great suffering to individuals affected by it and placing a major financial toll on the state or agency programs.”  The American Diabetes Association has noted that the growth of Diabetes in the United States is growing at epidemic proportions. The Centers for Disease Control noted that as of 2017, over 9 percent of the population has been diagnosed with diabetes.
What is truly concerning about the diabetes epidemic is the insidious nature of the disease. For many, the disease presents no overt symptoms. In fact, 23.8% of the diabetic population had no idea that they suffered from the disease. As people, who are seemingly symptom free, defer primary care physician visits due to rising health care costs, the diabetes epidemic will worsen.
Recognizing the growing prevalence of diabetes in their patient population, Pennsylvania optometrists decided that they needed to find a way to move patients into treatment. Interestingly, diabetes is one of 273 specific diseases that manifest in the eye. Before a patient has overt symptoms of diabetes, it is not unusual for there to be signs of diabetic retinopathy. This medical reality allows optometrists to provide patients with early notice of the need for diabetic treatment and management.
Providing earlier notice of the presence of diabetes is key to managing the disease. It affords patients the opportunity to change diet and lifestyle before complications arise. It allows for management of the disease rather than treatment of life-altering complications. This recognition provided the basis for the Pennsylvania Optometric Association to form the Pennsylvania Diabetic Eye Health Alliance, a group of optometrists dedicated to the identification, treatment, and referral of diabetic patients.
This group of dedicated primary eye care professionals recognized that to truly make a difference it was necessary to find partners in the efforts to identify patients who were diabetic. Importantly, health insurers also had a similar interest in assuring that diabetic patients were identified and placed in treatment. Health insurers have two significant financial interests in treatment of diabetes. First, controlling the disease reduces costs of treatment. Prevention is always less costly than treatment of complications. Second, carriers’ effectiveness in disease management is measured through HEDIS and STARR scores. The ability to keep people in treatment is a metric used in determination of these scores. For every percentage increase in these scores carriers can realize 1.5 million dollars in indirect financial benefit.
Combining the desire of doctors of optometry to identify diabetic patients with the desire of carriers to more effectively keep diabetic patients in care, led to the creation of a partnership between the Pennsylvania Optometric Association and the Geisinger Health Plan. Geisinger Health Plan administrators identified those patients who were diabetic and were also patients of members of the Diabetic Eye Health Alliance. Working with the PADEHA doctors, Geisinger provided lists of patients who had been lost to follow-up. These doctors then contacted their patients to encourage a return to treatment. This effort resulted in returning up to 70% of patients to care. This program proved to be the most effective effort to manage a specific disease in the Geisinger Health Plan history, having achieved recapture rates greatly in excess of any prior programs.
The program was so successful, other health insurers have expressed interest in working with the POA and the PADEHA. The Joint State Government Commission has also recognized the success of this program in its most recent diabetes report. It has suggested that partnerships like this need to be explored and expanded. Bringing together normally antagonistic parties to find common ground can produce amazingly productive partnerships.
 JOINT STATE GOVERNMENT COMMISSION General Assembly of the Commonwealth of Pennsylvania
DIABETES IN PENNSYLVANIA: PREVENTION AND MAINTENANCE PROGRAMS, STAFF STUDY
MARCH 2018, p. 1.
 American Diabetes Association. The Burden of Diabetes in Pennsylvania, http://main.diabetes.org/dorg/PDFs/Advocacy/burden-of-diabetes/pennsylvania.pdf (accessed August 29, 2017)
 Centers for Disease Control, National Diabetes Statistics Report 2017
The information contained in this publication should not be construed as legal advice, is not a substitute for legal counsel, and should not be relied on as such. For legal advice or answers to specific questions, please contact one of our attorneys.
Joseph A. Ricci, Esq., the Executive Director of the Pennsylvania Optometric Association
The views represented in this post are solely those of the author, and do not necessarily reflect the views of the Pennsylvania Optometric Association.