Older adults with diabetes in managed care networks have higher rates of untreated eye disease

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.

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."