05/19/2022

More than 37 million Americans have diabetes, according to the Centers for Disease Control and Prevention (CDC). Because symptoms can develop slowly, one in five don’t know they have it. You may play an important role in supporting our members through regular screenings, tests and office visits.

Closing Care Gaps

To help monitor and improve our members’ care, we track quality measures related to diabetes care.

Comprehensive Diabetes Care measures apply to members ages 18 to 75 with diabetes (type 1 or type 2) who had the following during the measurement year:

• Hemoglobin A1c (HbA1c) control (<8.0%): The most recent HbA1c level is less than 8.0%, indicating control.
• HbA1c poor control (>9.0%): The most recent HbA1c level is greater than 9.0%, indicating uncontrolled. A lower rate on this measure indicates better performance.
• Eye exam: An eye care professional screens or monitors for diabetic retinal disease via a retinal or dilated eye exam.
• Blood pressure control (<140/90 mm Hg)

Kidney Health Evaluation for Patients with Diabetes (KED) tracks members ages 18 to 85 with diabetes (type 1 or type 2) who received a kidney health evaluation. An evaluation is defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR) during the measurement year.

Tips to Consider

• Identify care gaps and schedule lab tests before office visits to review results and adjust treatment plans if needed.
• Document medication adherence to angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB) when applicable.
• Repeat abnormal lab tests later in the year to document improvement.
• Monitor blood pressure status at each visit and adjust medications as needed for control.
• Encourage members with diabetes to have annual retinal or dilated eye exams by an eye care specialist.
• Communicate with members and other treating providers to ensure all tests are completed and results are documented in the medical record.

Resources

We encourage you to talk with our members about diabetes. We’ve created information that may help, including:

·         Type 1 and Type 2 symptoms

·         Regular eye exams to avoid vision loss, or diabetic retinopathy

·         Screenings for kidney disease, or diabetic nephropathy

See our preventive care and clinical practice guidelines on diabetes.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

HEDIS is a registered trademark of NCQA.