CoxHealth Uses IRIS to Improve HEDIS Quality Measures


CoxHealth Drive Improvement in HEDIS Quality Measures with IRIS Diabetic Retinopathy Telemedicine Solution

Missouri-based health system and payer is preventing blindness, closing care gap in diabetic eye exams

PENSACOLA, Fla.– Oct. 17, 2016 – Intelligent Retinal Imaging Systems (IRIS) announced today that using the IRIS diabetic retinopathy telemedicine solution, CoxHealth administered the diabetic retinopathy exam (DRE) to 1,865 patients over an initial one-hundred-day period, diagnosing 305 (16%) with diabetic retinopathy who otherwise would have gone undiagnosed.

Of the 305 patients diagnosed with diabetic retinopathy, 283 were found to have non-proliferative diabetic retinopathy and 22 were given proliferative, vision-threatening diagnoses.

These results enable CoxHealth to achieve Healthcare Effectiveness Data and Information Set (HEDIS) quality outcomes that provide the best level of patient care and increased revenue from quality incentives. HEDIS is a tool used by more than 90 percent of America’s health plans to evaluate performance on process and outcomes in both clinical care and members’ care experience. Elevating HEDIS scores reflects a healthier population and results in reduced healthcare costs and increased health plan rankings and revenue.

“The IRIS diabetic retinopathy telemedicine solution allows us to offer comprehensive diabetic retinal exams simply,” said Brock Shamel, administrative director, for CoxHealth. “This solution not only closes a care gap for CoxHealth patients with diabetes, but also significantly supports our ability to improve our compliance rates.”

CoxHealth is Missouri’s only locally-owned, not-for-profit health system and the only locally-based health insurance company in the Ozarks. With approximately 24,000 diabetic patients system-wide, CoxHealth’s compliance rate for annual diabetic retinopathy eye (DRE) screenings, a key care gap for CoxHealth, had been at a low of 32 percent. The IRIS teleretinal examination program for diabetic retinopathy was installed at 14 specially selected CoxHealth locations, with two systems at one of the locations, Compliance rates are steadily increasing across multiple payer contracts with one key contract near 80%. 

In addition to improving HEDIS outcomes, CoxHealth is improving its Hierarchical Condition Categories/Risk Adjustment Factor (HCC/RAF) scores in risk-based contracts, which recognizes increased payments from its payers to care for their members. The 150 diabetic retinopathy diagnoses will directly elevate HCC RAF scores in patients with risk-based payer contracts.

“While improved HEDIS and RAF scores are very important, the true measure of success is ensuring patients with diabetes are properly diagnosed,” said Jason Crawford, CEO of IRIS. “CoxHealth’s implementation of IRIS’ intake to reimbursement solution for diabetic retinopathy and its integration into their EHR enables physicians to do what they do best – provide outstanding care to their patients.”

Key to the success CoxHealth has seen is the integration of the IRIS diabetic retinopathy solution with their EHR. This not only increases data accuracy and timeliness of results and reduces the burden associated with HEDIS reporting, but aids in efficiency and enables providers to focus on patient care.

Dr. C. Mark Costley, medical director, Regional Services, CoxHealth, describes the implementation as a “resounding success” and one he would like to emulate in other areas of the organization.

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About CoxHealth
CoxHealth is the only locally owned, not-for-profit health system based in Springfield, MO. It has been recognized with 28 number one ratings from CareChex, a division of Comparion Medical Analytics, and is nationally accredited by DNV-Healthcare. CoxHealth provides more than $122 million annually in community benefit to serve the unmet needs of its friends and neighbors. Established in 1906, the organization serves more than 900,000 people in a 25-county service area in southwest Missouri and northwest Arkansas, offering a comprehensive array of primary and specialty care including five hospitals and more than 84 clinics in 24 communities. The health system includes Cox Medical Center South, Cox Medical Center Branson, Cox North Hospital, Meyer Orthopedic and Rehabilitation Hospital, Cox Monett Hospital, Oxford HealthCare (the nation’s second largest hospital-based home health agency), Home Parenteral Services (home infusion therapy), CoxHealth Foundation, Cox College, Cox HealthPlans and more.

About IRIS: About Intelligent Retinal Imaging Systems

Intelligent Retinal Imaging Systems (IRIS) is a Pensacola, FL-based company founded in 2011 by nationally recognized retina surgeon Dr. Sunil Gupta, with a vision to end preventable blindness through the development and deployment of retinal screening services in the primary care setting.  The company’s IRIS solution is an FDA-cleared, cloud-based service that has improved quality, expanded access and reduced costs for diabetic retinopathy exams across the U.S. A team of physicians, technicians and practice management experts at IRIS seek to partner with forward-thinking providers and payers to enhance quality patient outcomes and the overall healthcare system. IRIS is the recipient of the 2016 New Product Innovation Award in Diabetic Retinopathy in North America by Frost & Sullivan. For additional information, visit

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