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 attachment to view full details

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

Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin (BCBSWI), Compcare Health Services Insurance Corporation (Compcare), and Wisconsin Collaborative Insurance Company (WCIC). BCBSWI underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CR-075522-24-CPN74976

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