MedCity Influencers, Diagnostics

How to curb the high cost of diabetic eye disease

The Centers for Disease Control and Prevention found that diabetes-related blindness costs can total more than $500 million per year, but eye care screenings are one of the easiest and most cost-effective ways to detect diabetes early and get patients the treatment they need.

The American Diabetes Association estimates that more than 30 million Americans have diabetes, yet nearly 25% of them aren’t even aware they have the disease. While many people rely on a high-fasting blood glucose test to determine if they have or are at risk for diabetes, there is another reliable, non-invasive way to detect the disease: an eye exam.

During an eye exam, care professionals can examine the optic nerve, the retinal blood vessels and the back of the eye. In doing so, they may notice leakages in the small capillaries in the retina, which often indicate diabetic retinopathy.

Even if diabetes has not been diagnosed, those telltale leakages are a sure sign that the patient has the disease. In fact, 20 percent of people first learn that they are diabetic as a result of an eye exam.

The health costs of diabetic eye disease
Untreated diabetes can lead to serious consequences, including neuropathy, amputation, blindness and even death. When it comes to vision health, diabetics are at risk for several issues, including glaucoma and cataracts, as well as a blinding condition called diabetic retinopathy, which can cost people their independent lifestyles.

Diabetic retinopathy occurs when the amount of glucose in the blood is poorly controlled, causing tiny blood vessels in the retina to break, swell, leak or grow abnormally. As the disease progresses, blood vessels become blocked and the retina doesn’t get the nourishment it needs, so it sends signals to grow more blood vessels. The new blood vessels are more fragile, often leaking fluid or blood and causing patients to experience blurred vision and blindness.

About 30% of people with diabetes have diabetic retinopathy. Thankfully, early detection and treatment can reduce the risk of blindness from the disease by 95%. Research shows that early intervention can have a significant impact on saving your sight, as evidenced in a study from the journal Diabetes Care, which found the risk of developing diabetic retinopathy is reduced by 76% and progression slowed by 54% in response to intensive treatment.

Clearly, early intervention is central to the successful treatment of diabetic retinopathy. And that means early detection is critical, given that patients are typically asymptomatic when the condition is in its early stages when treatment has the greatest likelihood of success. That’s why an annual eye exam should be the cornerstone of any health and wellness program for diabetics.

The financial costs of diabetic eye disease
Not only can diabetes take a physical toll, but it can also have a devastating financial impact.

The American Diabetes Association estimates that diabetes costs the U.S. $327 billion annually, with $237 billion coming from direct medical costs and $90 billion coming from decreased productivity. And with nearly 30% of diabetics suffering from diabetic retinopathy, it’s not surprising that the Centers for Disease Control and Prevention found that diabetes-related blindness costs can total more than $500 million per year.

In fact, a 2017 study from PLoS One found that medical costs for diabetics were significantly higher for those with diabetic retinopathy than those without the disease. Moreover, the same study found that those diabetics with even moderate diabetic retinopathy had notably higher medical costs than those associated with other diabetes-related conditions, including neuropathy and chronic kidney disease.

This was further evidenced in the Medicare population specifically. In a study from the journal Retina, researchers looked at the costs associated with diabetic retinopathy. They examined 5% of Medicare claims data from 1997 through 2004 and identified 178,383 controls (people with diabetes but no evidence of diabetic retinopathy), 33,735 cases of nonproliferative diabetic retinopathy (NPDR), and 6,138 cases of proliferative diabetic retinopathy (PDR).

Researchers found that average annual Medicare payments for ALL care—as well as the average payments for ophthalmic care specifically—were significantly higher for both the NPDR and PDR cases. And of those, payments in both categories were substantially higher for PDR cases than NPDR.

The takeaway? Because prevention is one of the most impactful ways to curb spending, eye care screenings are one of the easiest and most cost-effective ways to detect diabetes early and get patients the treatment they need.

Three tips for supporting vision in diabetic patients
There are several ways to support wellness for patients with diabetes and reduce the risk for and severity of diabetic eye disease.

  1. Be proactive. When a medical claim is submitted, assessing diabetes risk and management through lifestyle questions can help identify patients who may be at risk for the disease and require more intensive oversight.
  2. Set reminders. Annual reminders for diabetic patients to get a retinal exam help to keep patients on top of their health and prevent vision deterioration. Completing an eye exam annually improves the quality measure (DRE) for diabetics, which helps health plans increase their overall HEDIS and Star measures.
  3. Review both medical and vision claims. Both routine and medical claims from an eye care professional offer a wealth of data that can be factored into predictive analytics to proactively detect diabetes and/or diabetic retinopathy.

If left untreated, diabetes can have a blinding impact on patients, both physically and financially. Fortunately, early detection and treatment of diabetes through an eye exam can reduce the risk of blindness and other serious health impacts, as well as curb overall health costs for patients. By supporting vision care and screenings in diabetic patients, providers gain insights into the whole-body health of patients and can better manage their conditions.

Photo: Jay_Zynism, Getty Images

Elizabeth Klunk is the Senior Vice President of Medical Management at Versant Health , a managed vision care company focused on creating an integrated and seamless experience for health plans, members, and eye care professionals across the total eye health value chain.

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