MedXM Diabetic Retinopathy Solution Makes Screening Convenient

July 31, 2017 Jeanette Stern


MedXM Diabetic Retinopathy Solution Makes Screening Convenient


Santa Ana, CA: Santa Ana, CA, 7/31/2017 - While the baseline justification to leverage a telemedicine-based program to perform Diabetic Retinopathy Exam’s (DREs) is cost effectiveness, the benefits of leveraging telemedicine to Close Care Gaps are far more significant. Sending a trained technician into a home to capture high quality retinal images is far more cost effective and scalable than other options, and technology enables a more robust diagnostic experience.


Moreover, the quality measure as defined by HEDIS states a comprehensive, dilated eye exam or fundus photo with interpretation. Understanding this otherwise non-compliant patient population and its behaviors, we must find innovative ways to bring care to patients who are unwilling to receive levels of care to help better control the health of the population. While a full dilated eye exam offers the most comprehensive screening, working with non-compliant patients means using all tools available to meet the measures without “using a sledgehammer to drive a thumb tack”.


  • Speed to delivery.

    • Reaching more patients faster means increased compliance.

    • Reducing time from in-home visit to diagnostic result means documentation is automated –increasing speed to result and minimizing documentation errors.


  • Scalability.

    • Minimally licensed, well-trained camera operators mean replicable programs of high quality at lower cost.

    • Physician credentialing across state lines means consistency, expertise, and physician resource optimization.

    • Microsoft hosted, cloud based platforms mean built in redundancies for scalability.

    • The only limiting factor is can the insurance provider get us the patients fast enough for us to execute.


  • Increased Risk Dollars to better manage your patient population.

    • When using a diagnostic tool as detailed below, patients are coded to the highest level of severity. This means payers receive higher Per Member Per Month payments from CMS to manage their patient populations.

    • Faster completion rates mean more risk dollars at the beginning of the year rather than spread throughout.


  1. FDA Class II Clearance as a Diagnostic Test

With an upgraded telemedicine solution, Camera Technicians are trained to use the first and only Class II telemedicine platform for diagnosing diabetic eye disease. This Class II Clearance means that, when Diabetic Retinopathy (DR) or Macular Edema (ME) are found –true ICD-10 diagnoses codes are returned, and the PCP can enter the confirmed diagnosis code directly into the patient medical record. Depending upon the recommended Care Plan for the pathology by severity, the patient may require a referral to a specialist. However, mild pathology can be treated by a more aggressive care plan in the PCP office.


For the payers, identifying and treating DR early means overall costs of managing the disease can be significantly reduced through proper care and education in the PCP office avoiding the costlier expenses involved with specialty care.


Until this recent transitional upgrade, some payers may have required an Optometrist at the patient’s home to confirm a diagnosis rather than perform a screening. Additionally, an Optometrist may find additional disease during the visit. With the new technology, the grading, cloud-based physicians will identify a wide range of pathologies including, but not limited to, Glaucoma, HTN Retinopathy, Macular Hole, Epiretinal Membrane, Vein Occlusions, and the technology can often even see through / identify Cataracts. Many of these diseases may be identified by a visiting Optometrist, but specialists may see more in an image that has been enhanced for interpretation purposes.


  1. Increased Risk

Payers experience increased risk adjustments because MedXM provides a true diagnostic encounter to increase risk of a population due to a FDA Cleared Class II medical device combined with MD's diagnosing diabetic pathology.


In a risk model, and all payers are in risk models, the quicker the risk of a population is increased near the front of the year, the quicker the payer starts recognizing the increased revenue from CMS. Scalability, combined with ICD-10 diagnostic coding, increases this risk exponentially. Additionally, the ICD-10 data is automated, based on predetermined algorithms, to minimize any coding errors coming from the manual processes for an Optometrist to document the result back in his office. The ICD-10 codes transfer back with the final, graded result including the original images, to provide PCPs the most accurate documentation for inclusion into the patient medical record.


  1. Proprietary Image Enhancement for the Handheld Camera Technologies

The Reading Center uses a proprietary software with multiple algorithms built in to optimize the grading experience. Specific for handheld camera technologies, this image optimization ensures that the physicians in the Reading Center will see detail otherwise potentially missed by viewing with the naked eye, or in a “store-and-forward” image transfer software or thumb drive.


While image optimization is essential for diagnosing DR, the algorithms also use an auto-read feature only for the purposes of triage –not diagnosing. The algorithm reads patient images with abnormalities with highest level of risk first so that the grading physicians grade results in order of risk and severity rather than first in-first out. This means that the payers will have the opportunity to quickly triage any high risk patients in the timeliest manner. In some instances, the Reading Center may even identify co-morbidities which allow PCPs to refer patients to other, life-saving specialties such as Cardiology.


  1. Business Continuity assured by Award-winning technology for Innovation in Operational Efficiency

This technology was recently recognized at the 2017 HIMSS conference for Healthcare Innovation by Microsoft Health. This is important for many reasons, but at the core, important for redundancies and business continuity. Because this is a hosted solution, and leverages the Microsoft Azure platform for secure data transfer of images and results, Microsoft doesn’t have issues of switching servers to accommodate multi-state / geography initiatives. For payers, this means your data is not only secure and your graded results more reliable, but your valuable patient data is protected from network-based loss as well as protected from potential user errors. Workflows and safety nets are baked into this solution.


  1. Reading Center with Medical Oversight by Johns Hopkins Wilmer Eye Institute

The Reading Center uses licensed Retina Specialists, Ophthalmologists and Optometrists to interpret all exams. Because all exam images go through the enhancement algorithm, and are graded in a National Reading Center with oversight by Retina Specialists, often microvascular changes may be observed in the optimized photos that may have been otherwise missed. The Reading Center also leverages the robust, FDA Class II Grading Platform which not only allows grading physicians to identify and diagnose pathology, but proprietary functionality also allows grading physicians to demonstrate their physical observations in both routine findings and complex pathologies. In standard, store and forward based image viewing software, typically physicians are limited to drop down selections and basic functionality. However, we work closely with Legal and Compliance teams from several of their clients to ensure physicians can “show their work” within documented Results Reports.


  1. Population Health focused partnership for best payer outcomes

MedXM selected this new technology, in part, because of the strong focus we have in the field of Diabetic Population Health. With managing the health of at risk populations while reducing costs is Gold Standard for payers, MedXM understand that technology is only as good as the people using it. New training for Camera Techs involve overviews of Healthcare Quality and why getting the best images in the patients’ homes means these technicians are preventing blindness and contributing to the most important healthcare goals in US Society today. This level of engagement changes a technician’s view of doing a job versus now ending preventable blindness. Overall program quality should improve, and image gradability is a key performance metric. Incorporating the Reading Center, the optimized technologies, licensed physicians using robust grading tools, along with empowered, Population Health focused camera techs, improves the overall delivery model to leverage Camera Techs in patient homes.


About MedXM: Since 1990, MedXM has been a national leader in the design and implementation of preventative care technology and in-home health risk assessments for the purpose of care management. MedXM offers a complete network of connections between members, their health plan, and providers. MedXM is focused on delivering Risk Adjustment and Quality Solutions by providing clients with fully customizable healthcare solutions to fulfill specific needs.

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