Screenings for members with diabetes
BCBSRI’s PQIP program currently includes three diabetes-specific HEDIS measures that encompass important aspects of monitoring in patients with diabetes:
- Glycemic Status Assessment for Patients with Diabetes (GSD)
- Kidney Health Evaluation for Patients with Diabetes (KED)
- Eye Exam for Patients with Diabetes (EED)
If your practice uses an electronic medical record system, using an order set or workflow within the existing EMR to address all aspects of diabetic monitoring may reduce the number of missed opportunities in each of these measures. It may also ease the mental load providers often face when addressing diabetic care during an already busy appointment where members likely have many concerns or questions about their overall health.
Important parameters for diabetic screenings:
- Glycemic status assessment:
Members with diabetes (types 1 and 2) whose most recent glycemic status (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) was at the following levels during the measurement year:
- Glycemic status < 8.0% (commercial)
- Glycemic status < 9.0% (Medicare)
- Kidney health evaluation:
It is important that both an eGFR and a urine creatinine/albumin are completed and coded for. Please refer to the 2024 PCP Quality Incentive Program booklet for additional guidance on measures and recommended codes for gap closure.
Measure overview: Members with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by:
- An estimated glomerular filtration rate (eGFR)
- AND
- A urine albumin-creatinine ratio (uACR), during the measurement year
- Retinal eye exam:
Members with diabetes (type 1 and type 2) who had one of the following:
- A retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in 2024
- A negative retinal or dilated eye exam (negative for retinopathy) by an eye care professional in 2023
As always, the Quality Concierge team is available to answer any questions you have. Please reach out at QualityHEDIS@bcbsri.org.