Improving Patient Compliance: How the IRIS Digital Retinal Screening Solution Changed Gateway Medical’s Treatment Plan

diabetic retinal screening

Gateway Medical Associates is a large physician-owned practice based in Pennsylvania. Founded in 1996, Gateway consists of both physicians and allied health providers across nine different states. 

Gateway strives to provide excellent care for their patients and is at the forefront of doing so; deploying cutting-edge, disruptive solutions to provide a holistic healthcare experience for those they serve.

Key Metrics

2,847 or 23.9%

Percentage of patients diagnosed with some form of eye pathology

1,590 or 13.3%

Number of patients diagnosed with diabetic retinopathy


Total diabetic retinal screeing exams


The Challenge: Get Patients to Comply With Diabetic Retinal Screenings

In early 2016, Gateway Associates identified a need to improve their patients’ compliance in quality programs. More specifically, they had more than 7,000 patients in their diabetic population and could not get the vast majority of them to visit their eye doctors for an annual diabetic retinal screening. A diabetic retinal screening is vital to identifying diabetic retinopathy, a sight-threatening disease that is the leading cause of blindness in working-age adults. The blindness caused by diabetic retinopathy is preventable when the disease is caught early, but that can only be possible if patients comply in yearly diabetic retinal screenings.


Gateway, like other healthcare organizations, is held accountable for ensuring its patients receive this exam, but had no means to ensure that their patients were getting diabetic retinal screenings. Thus, despite the fact that Gateway knew that their patients weren’t complying with these yearly exams, they were having trouble figuring out how to increase the percentage of patient compliance. 


Several barriers preventing patients from going to receive a diabetic retinal screening included confusion about insurance, misconstruing it as an optical exam for glasses, and getting access to an ophthalmologist. 


Gateway needed to remove all barriers to their patients getting diabetic retinal screenings not only for the sake of their patients’ health, but also to raise their performance as a medical institution. They are heavily involved in quality programs and risk-based contracting, meaning the organization could be penalized for not attaining Healthcare Effectiveness Data and Information Set (HEDIS) quality scores and low-performing ACO measures. At the time Gateway started looking for solutions, they had less than 50% compliance on the HEDIS measure of diabetic retinal screenings, lower performance in KPIs for their ACO affiliations, and low STAR performance. They had everything to gain by finding a compliance solution: reducing costs, improving quality care, and increasing patient access to preventative healthcare.


Gateway Medical: Solution

To increase patient and HEDIS compliance, Gateway needed a technology that would seamlessly integrate into their existing infrastructure. The solution would also need to provide a means for performing a diabetic retinal screening in-office, as well as a way to diagnose optical pathologies.


For a solution that encompassed all of these needs, Gateway decided to partner with IRIS, an FDA-cleared, Class II medical device that provides digital retinal screenings and can diagnose eye pathologies like diabetic retinopathy from the cloud. The IRIS program provides a diagnostic solution that is fully supported by a bidirectional Allscripts EHR interface to capture all diagnostic information, document outcomes, and ensure results. These results are then delivered in discrete, structured data sets imported straight to medical records.


Gateway keeps their patients’ medical records organized and simple; every patient has a printed report card that shows everything from demographic information and insurance to any relevant quality measures that are outstanding. This allows for easy identification of patients who need a digital retinal exam. After the need is determined, it then takes five minutes for any medical employee, clinical or administrative, to administer the digital retinal exam. Overall, these IRIS exams take less than five minutes and do not require patient dilation.


Once the high quality images are taken, they are sent via IRIS’s FDA Class-II diagnostic telemedicine platform to the Gateway Eye Specialists in the IRIS Reading Center for expert interpretation. After these licensed eye care providers have examined the images, they are sent back to patient charts via IRIS’s EHR integration, along with any referral recommendations. From there, data is generated to commence the referral and billing cycle.


Gateway implemented IRIS technology in eight clinics in October of 2016, with a goal of reaching over 85% compliance with digital retinal screenings in their diabetic patients. In 19 months, 4,153 unique patients were examined out of their 7,774 diabetic patients, around 53% of the patient population. 


Meghan Fleck, Gateway Quality & Pay for Performance Manager, spoke on how IRIS has transformed Gateway Associates, “We were concerned that this would be one more thing to do, one more stop on the way to the exam room. The last thing we wanted to do was add to our clinical staff’s workflow. However, from the beginning, we involved everyone in the process and IRIS helped educate our staff. Training has gone very well and adoption is constantly improving. The flow is smooth, from greeting the patient to the vital signs to the IRIS test to the exam room.”


Results of Implementing IRIS’s Digital Retinal Screening

Although it has been difficult to convince patients of the value of digital retinal screenings and help them understand insurance and costs, Gateway has seen a drastic increase in compliance with diabetic retinal screenings since working with IRIS.


Before implementing IRIS technology, the physicians at Gateway were referring their patients to an external opthamologist to receive their annual diabetic retinal screening. However more often than not, Gateway physicians could not check off the quality box when it came to patients actually receiving those exams.


Now, the entire diabetic retinal screening is performed in the PCP office, takes less than five minutes to complete, and often does not require dilation. These factors make it much more convenient for both the patients and the Gateway medical provider, who can easily integrate this process into their existing workflow. Results of the exam are instantly transmitted to the patient EHR, allowing the primary care physician to make necessary referrals or suggestions for follow-up.


Initially, Gateway encountered some pushback from local eye care providers, but once they realized that IRIS wsa catching severe diseases that would not have been discovered until the patient was in critical condition.


“When our physicians started testing patients in the office that weren’t compliant, they started getting reports back showing disease almost immediately”, said Susan Fleck, Gateway Director of Operations.”

“They saw patients in need of interventions that weren’t getting them, which is what they need to recognize this was the right thing to do. Once the eye speciality physicians started seeing patients come to them with diagnosed pathology they fully understood that we are sending patients that they might not see until it was too late to save their vision.”


With the help of their IRIS Client Success Director, Gateway has gone from a nearly 30% quality score to nearly 90% in less than a year. 


In less than 19 months, Gateway has examined more than 4,800 unique patients, diagnosing 25% with some form of ocular pathology. More than 14% of their patients have been diagnosed specifically with diabetic retinopathy, and they have been able to save 203 patients from advanced stages of sight-threatening disease. Those patients are all being referred to ophthalmology and retina specialists based on the severity of their cases, providing a referral stream that did not previously exist for those practices.


In what Gateway and IRIS are calling “The Halo Effect”, compliance is increasing across the board. The IRIS program has made the PCP, specialists, and patients more engaged, which ultimately leads to better patient and compliance outcomes. 


Gateway is dedicated to providing full-spectrum care to its patients, and working with IRIS adds considerably to that comprehensive care level.


*Program metrics as of November 5, 2021

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