RICHMOND, Va.—Over the course of two very busy days in December, the Anthem Healthkeepers MediBlue Medicare Advantage plans here, took huge leaps forward to gaining a higher HEDIS score for imaging the retinas of its Medicare patients with diabetes. HEDIS stands for Healthcare Effectiveness Data and Information Set, widely used by health plans to assess performance. An annual retinal exam is one of the measures of comprehensive care for patients with diabetes.

CareMore, a subsidiary of Anthem Blue Cross and Blue Shield, provides disease management programs in four care centers in Richmond. However, for its Medicare Advantage (MA) patients, it didn’t have a surefire way to have these patients with diabetes screened with retinal imaging, said Linda Larue, general manager and vice president of CareMore Virginia.

So the organization created a two-day venture that involved screening 92 patients, training 10 technicians and testing a system whereby it could send the images to an eyecare provider for review. Brenda Wells, Anthem Blue View Vision product management director, explained that CareMore has purchased two Volk Pictor Plus handheld retinal imaging cameras for use in the Virginia locations, as well as eight for the California locations.

The two-day program simulated the experience, with help from several key volunteers from Anthem Blue View Vision and EyeMed Vision Care. These volunteers were on hand to take images of patients in one exam room, and images were sent to another exam room, mimicking the telemedicine approach that would be used in the future. In that second room, Hal Breedlove, OD, a private practitioner from Virginia Beach, spent his days assessing these images, and determining whether these patients should be referred to an ophthalmologist or what the appropriate follow-up schedule for imaging should be.

In another exam room, Richard Hom, OD, Anthem Blue View vision optometric director, was taking images using a Zeiss VisuScout handheld imager, and those images were being read by Bryan M. Rogoff, OD, MBA, CPHM. Both Dr. Breedlove and Dr. Rogoff volunteered their time for this event.

Dr. Breedlove said, “I am passionate about being able to intercede with patients with diabetes. I’ve worked with patients who have gone blind from the disease, and we can keep this from happening.” Dr. Breedlove has a great referral relationship with retinal specialists in his area, but this experience would reinforce that the protocols he and his MD colleagues have developed are in line with referral protocols developed by Wilmer Eye Institute at Johns Hopkins University and Stanford’s DRG.

Dr. Rogoff, a Maryland-based consultant, said that he was particularly interested in seeing how the telemedicine approach being tested in Richmond could be applied to more optometric locations throughout the country. “As health care reform changes the landscape, we want to focus on medical services and keeping the cost down. Being able to offer a similar service and work in conjunction with other eyecare providers would be very helpful,” he pointed out.

Wells explained that the schedules will be set up so that the trained technicians will rotate through the CareMore clinics to take images of patients with diabetes. In the future, the images will be sent securely to a local independent OD, who will be contracted to review the image and recommend a follow-up schedule. “CareMore staff will take it from there, setting up appointments with doctors and ensuring that the patient makes it to these appointments.”

Larue adds that it’s a way to improve the HEDIS scores for Anthem’s MA plans, involve local ODs and protect patients’ vision. “Retinopathy is obviously a big issue for patients with diabetes. We’ve been working on a way to fix this, and we believe this might be it. It’s difficult to get on the schedule with contracting MDs, and this can expand our connection with local ODs. Patients for whom we can’t get a good image are referred for a full dilated exam.”

(L to R) Bryan Rogoff, OD , MBA, CPHM; Richard Hom, OD, Anthem Blue View Vision optometric director; and Hal Breedlove, OD, Virginia Beach, Va. took part in CareMore’s event. Dr. Breedlove reviews a retinal image taken in the exam room next door. The trial mimicked a telemedicine setup. CareMore Virginia’s Linda Larue (l) and Brenda Wells, Anthem Blue View Vision product management director.