Digital Health For Insurers

Digital Diabetic Retinopathy Screening increased compliance from 23% to 100% (vs. 31.3% traditional referral rate) at a primary care clinic.
The Vine Hill Study

Digital Diabetic Retinopathy Screening increased compliance from 10% to 45% at a large FQHC.
Underserved Communities

Digital Diabetic Retinopathy Screening increased retinal screening by 50% (from 50% to 75% compliance rate) a three IHC sites.
Indian Health Service

Wait times for DRS were reduced by 89% and rates for Diabetic Retinopathy Screening increased by 16%.
Large Safety Net Health Care System

Cost Savings Analysis for a Diabetic Retinopathy Teleretinal Screening Program Using an Activity-Based Costing Approach
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Cost-effectiveness of diabetic retinopathy screening programs using telemedicine: a systematic review.
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Internal Analysis
Retinal screening rate results from sample large FQHC sites after DigitalHealth/EyePACS Diabetic Retinopathy Screening implementation:

Site #1

Pre-DRS:  43.5% (1 month before implementation)
Post-DRS:  79.3% (12 months later)

Site #2

Pre-DRS:  10% (1 month before implementation)
Post-DRS:  54.41% (4 months after implementation)

Site #3

Pre-DRS:  27%
Post-DRS:  53%

Site #4

Pre-DRS:  27%
Post-DRS:  49%

While handheld retinal cameras are portable, lightweight, inexpensive and require less storage space, and may "check the box" when it comes to retinal screening program quality-of-care measures, there are no current commercially-available handheld retinal cameras that meet the American Diabetes Association's criteria for telehealth diabetic retinopathy.
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Having a covered benefit increases compliance rates with retinal screening, decreasing risk of vision loss.

The justification for PPS billing for remote DRS by FQHCs and RHCs is most simply described by the following excerpt from “Telemedicine and Federally Qualified Health Centers/Rural Health Clinics Questions and Answers” by the California Primary Care Association with endorsement of the CA Dept of Health Care Services (DHCS) in 2015:

“7. Consider when a FQHC/RHC has store and forward technology, such as a retinopathy scanner. A non-billable provider takes a picture of a patient’s eye and a billable provider sends the image to an ophthalmologist. The FQHC/RHC is contracting with the ophthalmologist. Is the encounter with the patient a reimbursable visit?

The FQHC/RHC can bill a visit for this encounter because a medical service was performed by a billable practitioner. The specialist can also bill Medi-Cal on a Fee-for- Service basis as long as the contract between the two healthcare facilities/providers does not compensate the specialist for his/her services.

Note: Reimbursement to FQHCs for the store and forward option is currently only available for teleophthamology, teledermatology, and as of July 2015 teledentistry.”

UC Berkeley bills the appropriate ICD-10, CPT codes, and the NPI of an optometrist to automatically capture HEDIS data.

This automatic capture drastically reduces payer's administrative costs by avoiding manual medical record review.