As the sun sank, 63-year-old Pat Raynor found it hard to focus on the road. The red and white tail-lights of the cars ahead were swimming in a haze. Raynor, a diabetic who lives in Hampton, Va., had long feared that the disease would harm her vision. As her night vision decreased she went to see a local optometrist and was startled by the procedures the optometrist was suggesting. As someone who deals with health policy through her position with the state’s health department, Raynor knew the shared care the doctor was suggesting was unusual.