431-P: Gaps in Retinal Screening among Medicaid Patients with Diabetes: A Natural Experiment for Translation in Diabetes (NEXT-D) 2 Study

Background: Medicaid patients face many challenges in diabetes treatment and have higher rates of complications, including diabetic retinopathy (DR). We evaluated eye exam rates over a seven year period among Medicaid patients with diabetes and assessed variation by state, Medicaid eligibility category, and race/ethnicity.

Methods: Using United Healthcare claims (eligibility, medical, pharmacy) and lab data, we identified Medicaid patients with diabetes >21 years of age who received care in practices with >1000 Medicaid patients between 2010-2016. Diabetes was defined by diagnostic codes, AIC > 6.5% and/or anti-glycemic medication prescriptions. DR was defined by diagnostic codes. We used serial cross sections to calculate annual eye exam frequencies and our logistic regression covariates included age group, gender, race/ethnicity, language, Medicaid program, common comorbidities, indicators for type 1 vs. type 2 DM, indicators for chronic eye disease, state and and state by year fixed effects. We also adjusted for clustering at the 3-digit zip code level and excluded states with vision care carve-outs.

Results: Among 160,108 Medicaid person-years with diabetes, overall unadjusted rates of annual eye exams ranged between 23-36% per year. Adjusted annual eye exam rates varied significantly between states (range: TN at 24%, NV at 44%,). Adjusted rates were also significantly higher in 2014-2016 (30-33%) as compared to the baseline rate in 2010 (26%) and among patients with chronic eye disease as compared to those without (53% vs. 22%). There were no significant differences in eye exam rates by race/ethnicity or Medicaid program.

Conclusions: The majority of Medicaid patients with diabetes in our study did not receive annual eye exams between 2010-2016. These findings highlight significant gaps in care and interventions are needed to increase adherence to DR screening for underserved Medicaid patients with diabetes.