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Using Telemedicine to Boost HEDIS, Reduce Risk and Fight Blindness

Missouri's CoxHealth is using a digital platform to diagnose retinopathy in diabetic patients, boosting clinical outcomes and value-based care incentives from its payers.

By Eric Wicklund

- A Missouri-based health system is using a telemedicine platform to improve quality measures for value-based care – and uncovering undiagnosed retinopathy in dozens of diabetic patients that could lead to blindness.

CoxHealth, a five-hospital network serving about 900,000 people in southwest Missouri and northwest Arkansas, uncovered more than 300 undiagnosed cases of diabetic retinopathy in 1,865 patient exams using a screening platform developed by Intelligent Retinal Imaging Systems (IRIS).

Of those diagnosed patients, 22 were found to have a vision-threatening condition, while the remainder were referred to treatment for non-proliferative diabetic retinopathy.

Based on the results of the 100-day study, the health system reportedly reached quality outcomes set by the Healthcare Effectiveness Data and Information Set (HEDIS), used by more than 90 percent of the nation’s providers to measure clinical outcomes.

In addition, CoxHealth is using the telemedicine platform to improve its Hierarchical Condition Categories/Risk Adjustment Factor (HCC/RAF) scores in risk-based contracts, which allow for increased payments from payers by improving member care.

"The IRIS diabetic retinopathy telemedicine solution allows us to offer comprehensive diabetic retinal exams simply," Brock Shamel, the health system’s administrative director, said in a press release. "This solution not only closes a care gap for CoxHealth patients with diabetes, but also significantly supports our ability to improve our compliance rates."

CoxHealth is one of dozens of health systems around the country turning to telemedicine and mHealth to address value-based care initiatives and achieve quality outcomes. Advocates say these platforms will be crucial in convincing providers to move from volume to value.

With roughly 24,000 diabetic patients in its population, CoxHealth officials said they were struggling to find a program that would address their needs in a timely manner. The health system was seeing about a 32 percent compliance rate for diabetic retinopathy eye (DRE) screenings, well below the level needed to meet value-based care outcomes – never mind the potential threat to hundreds of diabetic patients who weren’t getting needed eye exams.

So the health system turned to telemedicine, and integrated the IRIS platform in 14 primary care and endocrinology clinics and a residency program, with the data fed back into the health system’s Cerner EHR platform. During the first six weeks of the program, 18 percent of the 1,040 patients examined were diagnosed with some level of diabetic retinopathy and were referred to an ophthalmologist for further treatment.

C. Mark Costley, MD, CoxHealth’s medical director of regional services, says the telemedicine program is vital in enabling physicians to quickly and easily examine patients and analyze results.

“We felt we needed to place a sense of urgency on this project to ensure it got done,” Costley said of the 10-week program in a case study prepared by IRIS and CoxHealth. “We needed to get at least five or six months of data utilization to try and make an impact on RAF scores, since that is probably one of our weakest areas: HEDIS measures and payer metrics.”

Health system officials say the DRE compliance rate is now up to about 80 percent, while the platform has reduced the workload for the system’s primary care providers.

“As population health makes its way into our day-to-day operations, our physicians shouldn’t have to handle redundant tasks,” Shamel said in the case study. “They are a high-cost resource that should focus on diagnosing and providing care and maintenance to patients.”

“We’d love to make this the culture of change,” added Costley. “If we can get the compliance results and provide better quality care with this change, I think we can do anything.”

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Using Telehealth, mHealth to Advance Value-Based Care

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