State & FederalMedicaidSeptember 30, 2021

Diabetes testing and screening HEDIS measures

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Comprehensive Diabetes Care HEDIS® measure

The Comprehensive Diabetes Care HEDIS measure evaluates the percent of adult members 18 to 75 years of age with diabetes (type 1 and type 2) who had each of the following during the measurement year:

  • Hemoglobin A1c (HbA1c) testing
  • HbA1c poor control (>9.0%)
  • HbA1c control (<8.0%)
  • Retinal eye exam performed
  • Blood pressure control (<140/90 mm Hg)

 

Kidney Health Evaluation for Patients with Diabetes

Additionally, the Kidney Health Evaluation for Patients with Diabetes measure was added as a first year HEDIS measure in 2020. This measure evaluates the percent of members 18 to 85 years of age with diabetes who received a kidney health evaluation, including an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR).

 

Record your efforts

Document results in the in the member’s medical record: HbA1c tests and results, retinal eye exam, blood pressure, urine creatinine test, GFR test.

 

Helpful tips:

  • Have reminders set in your electronic medical record (EMR) to alert staff when a patient’s screenings are due.
  • Provide reminders to patients for upcoming appointments and screenings.
  • Draw labs in your office if available or refer patients to a local lab for screenings.
  • Refer patients to participating eye professionals for annual retinal eye exams.
  • Follow up on lab test, eye exams and specialist referrals and document in your chart.
  • Telephone visits, e-visits and virtual check-ins are acceptable settings for blood pressure readings and should be recorded in the chart.
  • Include Category II reporting codes on claims to reduce the burden of HEDIS medical record review.
  • Educate patients on topics (for example, home monitoring of blood sugar and blood pressure, taking medications as prescribed, and other healthy lifestyle education like diet, exercise, and smoking cessation).

 

Other available resources:

  • Clinical Practice Guidelines are available on our provider self-service website.
  • Contact the Health Plan for a copy of Quality Measures Desktop Reference for Medicaid Providers and the HEDIS Benchmarks and Coding Guidelines for Quality.
  • Diabetes programs may be available to our members, contact your Provider Solutions representative for more information.

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

 

NYE-NU-0337-21 August 2021

 

PUBLICATIONS: October 2021 Newsletter