Prisma Health Before IRIS
Diabetes continues to be the leading cause of blindness among working-age adults in the United States. Dr. Saccocio confirmed that diabetes is prevalent in South Carolina just like the rest of the country. She specified, "What we've been troubled with is how do we consistently and across the continuum of diabetes care take care of the whole patient? One of those areas of focus has been for diabetic retinopathy prevention? "Additional challenges that prompted seeking a solution included the need for an ophthalmology referral, difficulty with access to specialized eye care, poor annual exam compliance (30%), and struggling to receive exam results from local eye care providers.
Prisma Health began its search for a diabetic eye exam solution in 2017 and considered many factors before choosing a vendor. Ultimately, IRIS's market leadership, camera agnostic approach, ongoing client success support, bi-directional Epic EHR interface, and overall partnership philosophy influenced Prisma’s decision. Furthermore, Dr. Saccocio said, "Their singular mission is to end preventable blindness, it requires that hand-in-hand approach with operations to ensure that logistically, all of those tweaks are taken care of." Later, Katie added that ongoing client success support has been a tremendous asset, continually providing best practices, troubleshooting advice, and tips for engagement and overall program success.
How Does it Work?
A simple workflow was a critical consideration for Prisma Health when implementing a diabetic retinopathy program. Katie took us through the five-step IRIS process, starting with the exam itself, which takes only moments and most often does not require pupil dilation. Once images are captured, they are uploaded to the IRIS cloud-based platform, where proprietary software enhances each image to allow for optimized readability. Once uploaded, the images are reviewed or "graded" by Prisma Health's assigned licensed eyecare provider from the IRIS Reading Center which allows for a diagnostic result. Once graded, the final result is returned directly into Prisma's Epic EHR allowing for follow – up or referrals, if needed. "In the course of one business day, a start-to-finish result can happen," explained Katie.
Performance Data – All Time
Since the beginning of the IRIS and Prisma Health partnership in early 2018, over 4,000 exams have been conducted. Varying levels of pathology have been diagnosed in over 700 of those patients, a rate of nearly 20%. "But what's really cool are those IRIS saves," said Dr. Saccocio. She continued to explain, "those saves are the patients who have an urgency to pick up on this disease. We recognize that retinopathy has a process and a progression that typically occurs. These are the patients with severe or proliferative retinopathy, who have an immediate threat to their eyesight. This has allowed us to immediately call up these patients and provide direct access to ophthalmic care."
Understanding the Financial Impact
Like other Health Care organizations, Prisma Health recognizes there is a financial component when it comes to the overall effectiveness of their diabetic retinopathy program. "What we have found is that the fee for service (FFS) revenue alone is paying for the cost of the IRIS program," Katie shared. She continued to say that while it has not been 100% smooth sailing, that is mostly due to issues with individual payers which is commonly experienced when implementing a new service or standard of care. However, they have not experienced any payers who, across the board, do not reimburse for the exam. Overall, implementing the IRIS diabetic retinopathy program has provided significant value both to patients and the health system.
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