In the US, more than 4.2 million people aged 40 years and up are either legally blind or have low vision. And the leading causes of blindness and low vision are primarily age-related eye diseases such as age-related macular degeneration, cataract, diabetic retinopathy, and glaucoma. Studies have shown that 80% of chronic diseases could be eliminated by preventative measures. And for those of us living with a chronic condition (like eye disease), well-coordinated care offers patients more control over their health. 

 

We recently had the unique opportunity to work with Lumata Health, a company focused on Chronic Eye Conditions. They recognized a need to support patients by providing information about their condition as well as identifying barriers and gaps in care. Providing the chatbot program in an asynchronous manner (once a week and in between visits) enabled increased efficiency by guiding staff interventions directly at patient needs and defining best practices for the patient population.  

 

There were four main barriers/gaps in care identified:

• Difficulty affording medications

• Difficulty administering medication due to comorbidity

• Difficulty completing Activities of Daily Living

• Change in baseline condition

 

Here’s what we learned from administering the program over a 3-month pilot period:

• 28% of patients reported having difficulty affording medications which increases the risk of non-adherence and risk of blindness. Care Coordinators were able to target interventions to finding resources for all medications, offer the Nanodropper, Prescription Assistance Programs, insurance benefits and coordinate care with the provider to identify low-cost alternatives. Care Coordinators not only focused on eye medications but also on all medications and other resources that may reduce financial burden and increase ability to afford medications.

• 7% of patients had difficulty administering medications (eye drops and insulin) due to comorbidities such as arthritis or cognition. Care Coordinators were able to offer solutions to administering medications such as the Gentle Drop, set schedules, and coordinate with caregivers for assistance which reduces the risk of non-adherence and blindness.

• 12% of patients reported having difficulty completing Activities of Daily Living, such as driving, cooking, bathing, dressing, grocery shopping, etc. due to their chronic eye conditions. Care Coordinators were able to target interventions directly at the patient need. Interventions included finding transportation at low or no cost, connecting with low-vision services, finding low or no-cost housekeeping, equipping with adaptive devices and learning opportunities to cope with lower vision, and organizing meal delivery at low or no-cost through insurance or other community resources.  These interventions reduce the risk of injury due to low vision, medication confusion, and decrease social isolation.

• 65% of patients participating reported a change in their baseline condition (vision). Patients were instructed to report to the provider and given a link to directly contact their Care Coordinator. Care Coordinators were alerted to the change in condition and reached out within 24 hours. Interventions included assessment of symptoms, and calling the provider to determine the timing and need for an appointment. The Wholistics Chatbot enabled Care Coordinators and providers to identify increased intraocular pressures, retinal detachments and other worsening symptoms that could lead to blindness. This early intervention decreased the likelihood of hospitalization and additional resources to support a patient who goes blind.

 

These interventions have prevented patients from having an acute exacerbation of their chronic condition and significantly reduced the need for hospitalization and associated medical costs, as well as improving medication adherence, and increasing patient and provider satisfaction.

 

Benefits for CCM Program Providers

Basing our calculations on standard averages, we estimated that revenue generated is ~$54.52 for CCM patients and ~$102.44 for Complex CCM patients for each barrier.  The chart below shows estimated revenue and costs.

 

Assumptions:

• 210 participants at $5/per patient per month over 3 months (cost = $3,150).

• Using the responses that generated an alert and subsequent staff action, we estimated the cost of staff related to the program and the gross average revenue generated by claims. 

• Staff cost at $22/hour with an average of 20 minutes spent with patients ($7.33 per patient barrier).

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