Samuel U. Rodgers Health Center is a Federally Qualified Health Center (FQHC) based in Kansas City, Missouri. The Center offers medical, dental, behavioral health and other services to more than 25,000 patients across six sites in the Kansas City area. Access to care can be a challenge for the Center’s patient population as 92% of patients live below 200% of the poverty level and are eligible for sliding fee discounts, and 40% lack insurance coverage.
In 2019, Dr. Kalyan Gogineni, Director of Value Based Care, embarked on a project focused on the Center’s diabetic population. 35% of patients living with diabetes did not have their diabetes under control. At that time, 8% of patients living with diabetes completed the annual diabetic retinal exam. Those stats were alarming because diabetic retinopathy is the leading cause of blindness in adults,1 and early stages often have no symptoms.2 As part of the improvement project, Dr. Gogineni added diabetic retinopathy screening to the dashboard of metrics. With early diagnosis and treatment, vision loss from diabetic retinopathy is 95% preventable.3
The Center implemented a teleretinal program with the Welch Allyn RetinaVue 100 Imager and saw great value in offering diabetic retinal exams during routine primary care visits. But only having one device shared across multiple locations was a challenge from a workflow standpoint. In addition to workflow challenges, training and ease-of-use were also barriers for significant success.
Dr. Gogineni was introduced to the RetinaVue 700 Imager at a conference and believed the device could resolve ease-of-use and program adoption challenges the Samuel U. Rodgers Heath Center was facing. By transitioning to the RetinaVue 700 Imager, program compliance initially increased from 8% to 43% over the first 12 months. That data was used to support acquiring additional cameras to expand the program and ensure that a higher percentage of patients living with diabetes would have access to the recommended annual diabetic retinal exam.4
Funding was secured to purchase four additional cameras. By Aug 2024, compliance for diabetic retinal exam across all sites was over 84%, a more than 1,000% increase over four years. Dr. Gogineni reports, “Patients are happy that they can take care of this annual screening right at the Center without scheduling additional appointments with a specialist at a different location.”
Staff utilize the pre-visit module in their data warehouse (Azara DRVS, which is connected to the EMR) to identify care gaps. If a patient living with diabetes has an appointment at the Center for any type of visit (medical, dental, lab visit, etc.), it is mapped and flagged in the pre-visit planning module in DRVS that their annual diabetic retinal exam has not been completed. The retinal exam can be done as a walk-in visit during that appointment, to make it fast and easy for patients to have the exam. “Our strategy is: when the patient is in the building, let’s do everything we can for them,” says Dr. Gogineni.
“Offering a program that has the potential to prevent vision loss is so important for our patient population. Blindness has a huge impact on the patient and their family/ caregiver’s lifestyle and quality of life.”
— Dr. Kalyan Gogineni, Director of Value Based Care, Samuel U. Rodgers Health Center
“We are removing as many barriers as possible to the process of completing the diabetic retinal exam — including our internal workflows, patient fees and the patient experience,” said Dr. Gogineni. For patients who pay out-of-pocket for medical care, the Samuel U. Rodgers Health Center removed the financial barrier by making the diabetic retinal exam available at no cost.
“The RetinaVue Care Delivery Model helps us take the lead in a quality program that allows more patients to access the diabetic retinal exam in the primary setting.”
— Dr. Kalyan Gogineni, Director of Value Based Care, Samuel U. Rodgers Health Center
The leadership team made the decision to cover those costs for patients because it recognized the value of ensuring patients have access to the annual diabetic retinal exam. “Offering a program that has the potential to prevent vision loss is so important for our patient population. Blindness has a huge impact on the patient and their family/ caregiver’s lifestyle and quality of life,” says Dr. Gogineni. The investment the center is making to help preserve vision of patients is small in comparison to the potential cost of long-term healthcare expenses and quality of life implications of vision threatening disease that was not caught in time.
“Our teleretinal program is cost effective and the workflow is fast, efficient and does not require patients to schedule a separate appointment to complete the retinal screening exam,” said Dr. Gogineni. “The RetinaVue care delivery model helps us take the lead in a quality program that allows more patients to have access to the diabetic retinal exam in the primary setting.”
