Facilitating access to free diabetic retinal exams with a novel geospatial approach in a national Medicare Advantage population with diabetes

PURPOSE:

Evaluate the effectiveness of tailoring call-to-action letters with information on in-network vision care providers closest to a person’s home on the uptake of diabetic retinal exams (DRE) in a Medicare Advantage population.

METHODS:

Study participants with diabetes and eligible to receive a free DRE in 2012 (n=17,050) were identified from a national Medicare Advantage population. Participants had comprehensive eye benefits and were residents in one of twenty pre-selected metropolitan counties. One-third of participants were randomized to receive a standard call-to-action letter with a phone number to contact their insurer to set up an appointment. Another third were randomized to receive a geospatial call-to-action letter, which had contact and address information for up to three in-network vision care providers within a 15-mile radius of the participant’s address. Call-to-action letters were sent in May 2012. The control group received standard care without any letters. Differences in DRE rates were assessed after 7 months using chi-square analysis.

RESULTS:

DRE rates differed across the three groups (P=0.034), with highest DRE rate in the geospatial letter group (48.9%), followed by the standard letter group (46.9%), and the control group (46.2%).  The geospatial group had significantly higher DRE rates than the standard (P=0.044) and control groups (P=0.007).  There was no significant difference between the standard and control groups (P=0.487).

CONCLUSION:

Tailored call-to-action letters with information about local in-network providers were more effective in increasing DRE rates than standard letters. The convenience of having nearby providers identified may help members take action and receive their DRE.