Quality Management Optimizing HEDIS & STARSMedicare AdvantageJanuary 28, 2025

Eye Exam for Patients with Diabetes (EED) 2025

Healthcare Effectiveness Data Information Set® (HEDIS) is a widely used set of performance measures developed and maintained by NCQA. These are used to drive improvement efforts surrounding best practices.

HEDIS measure

This measure assesses the percentage of patients 18 to 75 years of age with diabetes (types 1 or 2) who had a retinal eye exam.

Numerator

Medicare Advantage patients ages 18-75 with diabetes who had a retinal or dilated eye exam by optometrist or ophthalmologist in 2025 OR a negative retinal or dilated eye exam by an eye care professional in 2024 

Denominator

Patients 18-75 years of age with type 1 or type 2 diabetes

Refer to attachments to view full details

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

Medicare services provided by Anthem Blue Cross and Blue Shield, trade name of Anthem HealthChoice HMO, Inc. and Anthem HealthChoice Assurance, Inc., Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC., or Anthem Blue Cross and Blue Shield Retiree Solutions, trade name of Anthem Insurance Companies, Inc.
Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BC-CR-075521-24-CPN74976, MULTI-BCBS-CR-075522-24-CPN74976

ATTACHMENTS: Eye Exam for Patients with Diabetes (EED) 2025 - Blue Cross (pdf - 0.53mb), Eye Exam for Patients with Diabetes (EED) 2025 - Blue Cross Blue Shield (pdf - 0.53mb)