Older adults with diabetes
in Managed Care Networks
have higher rates of untreated eye disease
Newswise — Medicare beneficiaries
at high risk for eye disease due to diabetes are more likely to have
unrecognized and untreated eye disease if they are enrolled in
managed care than if they have fee-for-service (FFS) health
insurance, according to an article in the May issue of Archives of
Ophthalmology, one of the JAMA/Archives journals.
Individuals aged 65 and older with
diabetes are at high risk for eye diseases, including cataract,
glaucoma and diabetic retinopathy (an eye disease in the retina that
can result in seriously distorted or blurred vision), according to
background information in the article. Although previous studies
have shown that appropriate ophthalmic care can reduce the
progression of eye disease and reduce or reverse visual disability,
eye care for older persons with diabetes may not be adequate. The
authors suggest that managed care has the potential to enhance the
coordination of primary and specialty care and increase access to
appropriate eye care for older individuals with diabetes. In some
states, including California, almost half of all Medicare
beneficiaries in managed care were enrolled in for-profit Medicare +
Choice plans in 1999.
Arleen F. Brown, M.D., Ph.D., of
the David Geffen School of Medicine at the University of California,
Los Angeles, and colleagues interviewed Medicare beneficiaries in
Los Angeles County with diabetes about their medical history and
health care and eye care service use. Ophthalmologic examinations
were performed to assess need for eye care services. The researchers
also evaluated whether the rates of need for eye care differed in
fee-for-service Medicare and the for-profit Medicare + Choice
network model (MC) managed care plan. The need for eye care within
six months of the eye examination was based on American Academy of
Ophthalmology guidelines and clinical judgment.
Three-hundred-eleven patients with
managed care health insurance and 107 with fee-for-service health
insurance completed the interviews and clinical examinations. The
researchers found high rates of untreated eye disease in individuals
with both types of insurance. Managed care patients had
significantly higher rates of cataract (36 percent versus 22
percent) and somewhat higher rates of diabetic retinopathy and
glaucoma, the authors report. Overall, managed care patients were
more likely to have at least one of the three eye diseases, diabetic
retinopathy, cataract, or glaucoma or suspected glaucoma, (68
percent versus 46 percent) than fee-for-service patients.
“Our findings indicate that older
adults with diabetes are at risk for undetected and untreated
age-related eye diseases, suggesting that more than just treatment
for retinopathy must be considered when evaluating the
appropriateness of the interval between eye care visits for older
persons with diabetes,” the authors conclude. “Additionally, older
adults with diabetes who were enrolled in a network-model managed
care setting were more likely to need care for treatable ophthalmic
conditions that comparable persons who obtain service under FFS
Medicare. Moreover, the majority of study participants had been seen
by an eye care specialist in the prior 12 months, and this did not
differ by type of insurance. This suggests that although access to
eye care visits is similar in the FFS and MC settings studied, the
content and quality of that care may differ.”