Op­tometrists eye big­ger role in man­ag­ing chronic con­di­tions

Modern Healthcare - - NEWS - By An­dis Robeznieks

Op­tometrists are work­ing more closely with physi­cians and in­sur­ers to iden­tify pa­tients’ chronic con­di­tions and en­sure those pa­tients re­ceive ap­pro­pri­ate med­i­cal care. They want to demon­strate that they have the train­ing and skills to do more than just fit peo­ple for glasses and con­tact lenses.

Char­lotte, N.C.-based Caroli­nas HealthCare Sys­tem is work­ing with Vi­sion Source, a King­wood, Texas-based net­work of 3,800 in­de­pen­dent op­tometrists, to boost its per­for­mance in serv­ing di­a­betes pa­tients and raise its di­a­betescare qual­ity score.

Last week, Vi­sion Source an­nounced that it en­tered into a re­la­tion­ship with Ar­ling­ton, Va.based Privia Qual­ity Net­work, a na­tional net­work and ac­count­able care or­ga­ni­za­tion for in­de­pen­dent physi­cians, to pro­vide eye health and vi­sion ser­vices to Privia’s pa­tient base.

Dr. Scott Fur­ney, in­ter­nal medicine depart­ment chair at Caroli- nas Med­i­cal Cen­ter, said Vi­sion Source op­tometrists are par­tic­u­larly help­ful in rais­ing his sys­tem’s scores on Healthcare Ef­fec­tive­ness Data and In­for­ma­tion Set, or HEDIS, mea­sures for di­a­betic retinopa­thy screen­ing.

“We have, for years, tracked di­a­betes out­come mea­sures and have ex­tremely high qual­ity scores and we’ve been work­ing very hard to im­prove our rate of screen­ing,” Fur­ney said. “It’s a mea­sure that’s been hard for us to move the nee­dle on with­out a part­ner­ship. But, more im­por­tant, it’ll help us to pre­vent blind­ness.”

Jim Greenwood, Vi­sion Source’s CEO, said op­tometrists, be­sides do­ing eye ex­ams, can take blood-pres­sure read­ings; mea­sure body-mass in­dex; and record age, height, weight and smok­ing sta­tus.

Other health sys­tems col­lab­o­rat­ing with op­tometrists af­fil­i­ated with for-profit Vi­sion Source in­clude CoxHealth, Spring­field, Mo.; Wel­lMed Med­i­cal Group, San An­to­nio; and Bap­tist Health South Florida’s 600-physi­cian Bap­tist Health Qual­ity Net­work.

The gen­eral public vis­its op­tometrist of­fices more fre­quently than any other part of the healthcare sys­tem, and savvy providers are learn­ing how to lever­age that to their pa­tients’ ad­van­tage. A 2013 white pa­per pub­lished by

in­surer Unit­edHealth­care said “the eyes are the win­dow into a per­son’s over­all health.” The white pa­per was ti­tled “In­te­grat­ing Eye Care With Dis­ease Man­age­ment: It’s Not Just About Di­a­betes Any­more.”

Unit­edHealth­care found that eye-care pro­fes­sion­als were ef­fec­tive in iden­ti­fy­ing pa­tients with di­a­betes, high choles­terol, hy­per­ten­sion, ju­ve­nile rheuma­toid arthri­tis and mul­ti­ple scle­ro­sis. In a study re­leased in May, the in­surer re­ported that eye ex­ams were ef­fec­tive in re-en­gag­ing pa­tients in needed healthcare. The study fol­lowed 2,300 Unit­edHealth­care mem­bers and iden­ti­fied those with chronic con­di­tions who had not sought care within the past 18 months. Ac­cord­ing to the study, 33% of these pa­tients made an ap­point­ment with a spe­cialty physi­cian or pri­ma­rycare doc­tor within 60 days of an op­tometrist visit and another 24% were en­gaged af­ter 60 days.

Unit­edHealth­care has used this in­for­ma­tion in its Bridge2Health pro­gram, which in­te­grates med­i­cal and vi­sion-care data while aim­ing to close gaps in care, iden­tify op­por­tu­ni­ties for in­ter­ven­tion and mon­i­tor 23 chronic con­di­tions.

Greenwood wel­comes the in­surer’s recog­ni­tion that op­tometrists can play a broader role in care. He’s seek­ing to ex­pand his net­work’s col­lab­o­ra­tions with provider sys­tems and in­sur­ers, but is find­ing that some­times it can be a hard sell. Be­fore join­ing Vi­sion Source in 2013, he ac­knowl­edged that he him­self saw op­tometrists as “the doc in the mall” who gave eye ex­ams and sold glasses and con­tact lenses. “That per­cep­tion is shared by roughly 90% of healthcare ex­ec­u­tives,” he said. “It’s a moun­tain that’s go­ing to be hard to climb.”

Greenwood has launched a cam­paign to show how op­tometrists can help pri­ma­rycare physi­cians im­prove pa­tients’ out­comes by iden­ti­fy­ing pa­tients whose health is at risk—es­pe­cially those with di­a­betes—and get­ting them more en­gaged in man­ag­ing their health. One tool is new tech­nol­ogy that al­lows di­a­bet­ics to see im­ages show­ing the con­di­tion of their own reti­nas. “It’s lit­er­ally open­ing eyes of di­a­bet­ics about the risk they are fac­ing—loss of their vi­sion—if they don’t take bet­ter care of their dis­ease state,” Greenwood said.

Dr. Linda Chous, an op­tometrist and chief eye-care of­fi­cer for Unit­edHealth­care, shares Greenwood’s vi­sion of a broader role for op­tometrists. “Peo­ple more of­ten vis­ited their eye doc­tor than their pri­mary-care doc­tor,” she said. “That gives an eye doc­tor in­creased op­por­tu­nity to iden­tify and mon­i­tor chronic dis­eases.”

Unit­edHealth­care’s most re­cent white pa­per on eye care de­tailed how chron­i­cally ill pa­tients be­came re-en­gaged with the healthcare sys­tem af­ter an op­tom­e­try visit. Chous said that un­der Unit­edHealth­care’s Bridge2Health pro­gram, a med­i­cal history of eye-care pa­tients is now taken in which pa­tients are asked about their med­i­ca­tion history. Of­ten, pa­tients tell their op­tometrist that they used to be on cer­tain med­i­ca­tions but stopped be­cause of side ef­fects or a lack of pos­i­tive out­comes. “We hear this over and over,” Chous said. “So we coun­sel these pa­tients that they need to see their pri­mary-care doc­tor.”

Greenwood and Chous said they are not aware of any con­cerns from pri­mary-care physi­cians or oph­thal­mol­o­gists about op­tometrists per­form­ing pop­u­la­tion-health man­age- ment-re­lated tasks or mon­i­tor­ing for chronic con­di­tions. That’s at least partly be­cause physi­cians ei­ther don’t have the time or be­cause pa­tients sim­ply aren’t go­ing to them.

Chous pre­dicted that the re­la­tion­ship be­tween op­tometrists and physi­cians will grow when it’s un­der­stood that chronic-dis­ease com­pli­ca­tions and costs can be re­duced by op­tometrists’ mon­i­tor­ing. She es­ti­mated in her white pa­pers that re­duc­ing blood-sugar lev­els can lead to de­creased med­i­cal uti­liza­tion and re­sult in an­nual sav­ings of $1,200 to $1,872 a pa­tient.

Dr. Michael Ear­ley, an op­tometrist and as­so­ciate dean of aca­demic af­fairs at the Ohio State Univer­sity Col­lege of Op­tom­e­try, said it helps that stu­dents in dif­fer­ent healthcare fields in­clud­ing op­tom­e­try are be­ing taught to work to­gether. On the first day of classes, Ohio State brings to­gether 800 to 900 stu­dents of medicine, den­tistry, nurs­ing, op­tom­e­try, phar­macy and other healthcare dis­ci­plines for a full-day pro­gram on how they in­ter­act to ben­e­fit the over­all health of their pa­tients. “Stu­dents are be­ing taught to co­or­di­nate care and treat the pa­tient as a true pa­tient—and not just a pair of eyes,” he said.

In ad­di­tion, op­tom­e­try stu­dents now must take full cour­ses in anatomy, pathol­ogy and phar­ma­col­ogy. “Op­tom­e­try stu­dents are tak­ing sys­tem­atic phar­ma­col­ogy cour­ses sit­ting in the same room as the den­tistry stu­dents,” Ear­ley said. “All the dif­fer­ent health pro­fes­sion­als are see­ing that their pa­tients need this kind of com­pre­hen­sive care and the cur­rent med­i­cal model is not de­signed to do it.”

When it comes to in­creas­ing scope of prac­tice, Ear­ley said, op­tometrists have to show that their train­ing goes “far be­yond” what they’re ask­ing for. For ex­am­ple, Ohio op­tometrists can’t per­form in­jec­tions, but Ohio State op­tom­e­try stu­dents still learn how to give them.

Ear­ley said younger physi­cians are more ac­cept­ing of the ex­pand­ing role for op­tometrists, but older physi­cians oc­ca­sion­ally are re­sis­tant. “Some docs still say, ‘No, I’m not go­ing to send my pa­tient to an op­tometrist, I’m only go­ing to send them to an M.D.,’ ” Ear­ley said. But younger physi­cians are less likely to have the stereo­type of an op­tometrist as some­one who only flips dif­fer­ent lenses in front of a pa­tient’s eyes.

The role of op­tometrists in pri­mary care and pop­u­la­tion health will in­crease, Ear­ley pre­dicted, be­cause there aren’t enough physi­cians to meet the de­mand for eye care and be­cause the points of con­tact are much more fre­quent. “We catch a lot of pa­tients who never go in to see a pri­mary-care doc­tor,” he said. “We need to have our place in the sys­tem.”

Caroli­nas HealthCare’s Fur­ney said that in the past his sys­tem’s clin­i­cians had prob­lems ob­tain­ing the re­sults of their pa­tients’ eye ex­ams af­ter re­fer­rals to op­tometrists. But work is be­ing done to de­velop an in­ter­face be­tween the Caroli­nas elec­tronic health-record sys­tem and Vi­sion Source op­tometrists’ of­fices. Since last sum­mer, re­ports have been trans­mit­ted over a ded­i­cated fax line and then scanned into the Caroli­nas EHR.

“It’s been a great re­la­tion­ship,” Fur­ney said. “If they iden­tify pa­tients at risk for health prob­lems, they re­fer pa­tients to our physi­cians who have be­come their lo­cal part­ners in care.”

“Stu­dents are be­ing taught to co­or­di­nate care and treat the pa­tient as a true pa­tient— and not just a pair of eyes.”

Dr. Michael Ear­ley Op­tometrist and as­so­ciate dean of aca­demic af­fairs at the Ohio State Univer­sity Col­lege of Op­tom­e­try

The gen­eral public vis­its op­tometrist of­fices more fre­quently than any other part of the healthcare sys­tem.

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