The HEDIS Comprehensive Diabetes Care (CDC) measure set includes screening rates for retinal eye exams, blood pressure, nephropathy screening, and rates of HbA1c control in patients with type 1 and type 2 diabetes.
Please note: HEDIS excludes Medicare members age 66 and older as of December 31 of the measurement year who are:
- Diagnosed with frailty and advanced illness during the measurement year.
- Enrolled in an Institutional SNP (I-SNP) any time during the measurement year.
- Living long-term in an institution (LTI) any time during the measurement year. – Organizations may use the LTI flag in the Medicare Part C monthly membership file.
Below are practice tips for the HEDIS Comprehensive Diabetes Care measures:
- Pre-visit planning may be useful. For members with upcoming appointments, medical assistants can mail a reminder letter and a lab slip to those due for HbA1c screening and other tests to help increase rates.
- Reinforce with members the importance of routine A1c testing as an indicator of diabetes control and help guide treatment planning.
- Obtain testing on an acute visit for patients who are non-compliant for routine screenings.
- For this measure, lower rates (of poorly controlled members with diabetes) are desirable.
- Consider Diabetes Disease Management for patients with diabetes.
- Consider endocrinology referral for complex or refractory cases
- Reinforce members' achievement of target A1c and its association with lower rates of complications.
- PCPs and optometrists/ophthalmologists should collaborate by sharing medical record information on their patient.
- The retinal eye exam may include (but does not require) dilation.
- Remind patients that diabetic eye disease can be asymptomatic, so routine exams are important for finding and treating problems early.
- Utilize CPT Category 2 code — 3072F — to identify diabetic eye exams negative for retinopathy in the year prior
- Dispensation of at least one ACE-I or ARB medication counts as evidence of treatment for nephropathy.
- Remind patients that like eye disease, diabetic kidney disease may be asymptomatic. Regular tests can detect issues early, when treatment may help delay disease progression.
- Pre-visit planning may be useful when screening tests are due. For members with upcoming appointments, have medical assistants note (schedules or records) that a urine test for albumin or protein is needed.
- Obtain testing* on an acute visit for patients who are non-compliant for routine screenings.
*This includes spot urine tests for albumin or protein.
- Discuss the importance of BP control especially given the additional cardiovascular risks for people with diabetes.
- Obtain and document two readings upon visit if initial reading is elevated.
BCBSRI offers a Disease Management program for Commercial members with diabetes. Interventions are based on risk stratification. All identified members (low risk) receive a mailing to introduce the program and provide educational material. A call-in line is also made available for additional information or questions. Diabetics with gaps in care (moderate risk) receive notifications recommending they contact their provider to schedule any necessary screening or testing.
Members stratified as high risk are offered the opportunity to participate in telephonic health coaching with a BCBSRI registered nurse or registered dietitian. The notification to high risk members who belong to a patient-centered medical home (PCMH) includes a recommendation that they contact the nurse case manager at their primary care provider’s office for assistance with their diabetes management.
If you have Commercial members who could benefit from the diabetes Disease Management program, please call the BCBSRI Triage Line at 401-459-2273 or email triage_group@bcbsri.org.