Encourage Diabetic Retinal Exams

According to a Centers for Disease Control and Prevention (CDC) study, the number of Americans with diabetic retinopathy is expected to increase from 5.5 million to 16 million by the year 2050. Diabetic retinopathy is already the leading cause of adult blindness in the United States. The good news, according to the American Academy of Ophthalmology, is 95 percent of vision loss due to retinopathy could be avoided if treated early.

Since early intervention is so vital and diabetic retinopathy often has no early warning signs, it is crucial that all diabetics receive a comprehensive dilated eye exam once per year from an eye care professional. An annual dilated retinal examination is included in the American Diabetes Association’s clinical recommendations and is also a Healthcare Effectiveness Data and Information Set (HEDIS) standard for comprehensive diabetes care. This exam will help uncover signs of retinopathy before symptoms are noticed and provide an opportunity for treatment to prevent vision loss and increase years of healthy life for people with diabetes.

A recent TriWest Healthcare Alliance study showed that 37 percent of diabetic TRICARE Prime beneficiaries in the West Region had a dilated retinal exam in the previous year. TriWest is taking steps to raise that rate towards the HEDIS benchmark of 64 percent, including reminder calls to beneficiaries through an Interactive Voice Response (IVR) system and targeted intervention letters to primary care managers (PCMs) of diabetic TRICARE beneficiaries.

Data supports that a primary care physician recommendation is a strong motivator in diabetic patients getting dilated retinal examinations. Diabetic patients are covered for one comprehensive eye exam every year when enrolled in TRICARE Prime and do not need a referral to see a military treatment facility (MTF) or network optometrist or ophthalmologist. There is no copayment for these exams. TRICARE also covers annual routine eye exams for active duty service members and active duty family members.

For more information about TRICARE’s vision coverage, view the quick reference guide on the TRICARE vision benefit, refer to the TRICARE Fact Sheet or refer to the TRICARE Policy Manual at http://manuals.tricare.osd.mil/.

Do you have ideas about how to increase retinopathy screening rates or concerns about barriers preventing your diabetic patients from receiving this vital exam? If so, we want to hear from you! Please contact Tracy Lenartz, Health Coach at TriWest Healthcare Alliance, at tlenartz@triwest.com.

Published Date: 04/30/2009