November 2018
Improving Coordination of Care for Our Members with Diabetes
Based on results from an August 2017 HMO primary care physician (PCP) survey, which was sent to 77 participating Medical Groups/Independent Physician Associations (IPAs), it has come to our attention that some members’ eye exam results from specialists are not being reported back to the referring providers.
According to the Centers for Disease Control and Prevention (CDC), diabetes is the leading cause of new cases of blindness in adults. This is an issue as the number of people living with diabetes is only increasing, which can correlate to an increase in people with blindness.1
Diabetes can cause a disease of the eye called diabetic retinopathy (DR). Best practice for diabetics is to have an annual comprehensive eye exam performed by an ophthalmologist or optometrist to determine if DR has caused damage to the eye, according to the American Diabetes Association (ADA).2 Routine eye exams may help providers pinpoint any changes. DR is treatable if caught early. Refer to the Diabetes Mellitus - Standards of Care on the Clinical Practice Guidelines page of our Provider website for evidence-based standards of care for diabetes.
Blue Cross and Blue Shield of Illinois (BCBSIL) performs annual assessments through claims filed and review of medical records data. Results indicate that not all members with diabetes receive an annual diabetic eye exam. You are the key to help ensure that members receive this important evaluation and results are properly documented in the referring practitioners’ records. This quality improvement initiative depends largely upon communication between eye care specialists and referring providers.
We appreciate the care and services you provide to help improve the health and well-being of our members. With your continued help, it is possible to help improve the coordination of care for our members with diabetes. Below are some tips you may want to consider with your diabetic patients:
- If you are the referring provider, you may want to consider including a note with your contact information along with the referral asking the eye care specialist to send the results back.
- If you are the eye care specialist, it may be helpful to include a note or letter with your contact information indicating that an ophthalmoscopic exam was completed and include the results of exam, which may be done by adding a photograph of retinal abnormalities.
1 CDC, Diabetic Retinopathy, https://www.cdc.gov/isionhealth/pdf/factsheet.pdf
2 ADA, Standards of Medical Care in Diabetes, Jan. 1, 2018. https://professional.diabetes.org/content-page/standards-medical-care-diabetes
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The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.