11/06/2023

People with diabetes are at a higher risk of vision loss and eye diseases, but 60% don’t get annual eye exams, according to the Centers for Disease Control and Prevention (CDC). Early diagnosis and proper treatment can greatly lower the chance of blindness from diabetic retinopathy. You may play an important role in supporting our members with diabetes by encouraging an annual retinal or dilated eye exam by an eye care specialist.

In its Standards of Care in Diabetes 2023 for retinopathy, the American Diabetes Association recommends annual dilated retinal exams by an ophthalmologist or optometrist for members with any signs of retinopathy. See our preventive care and clinical practice guidelines for more information on diabetes.

Monitoring Our Members’ Care

We track Eye Exam for Patients with Diabetes (EED), a Healthcare Effectiveness Data and Information Set (HEDIS®) measure from the National Committee for Quality Assurance (NCQA). EED captures the percentage of our members ages 18 to 75 with diabetes (type 1 and type 2) who have a retinal eye exam by an eye care professional during the measurement year to screen or monitor for diabetic retinal disease. 

To help close gaps in care for this measure, consider the following:

• In early stages of retinopathy, people often don’t experience any symptoms. Discuss the importance of annual eye exams with our members who have diabetes, including members who are planning to be pregnant or are pregnant. We’ve created information that may help.
• Consider building care gap alerts for eye exams in our members’ electronic medical records and sending them reminders.
  
• We encourage eye care specialists to communicate exam results to our members’ primary care providers to help coordinate care.
  

We track additional quality measures for our members with diabetes:

• Hemoglobin A1c (HbA1c) Control for Patients with Diabetes, Blood Pressure Control for Patients with Diabetes and Kidney Health Evaluation for Patients with Diabetes: Learn more
  
• Statin Therapy for Patients with Diabetes: Learn more
• Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who are Using Antipsychotic Medications (SSD): Learn more

Resources

For Texas Medicaid Provider Quality Improvement, review the following resources ranging from quality measures data to current vaccine schedules:

• BCBSTX Preventive Care Guidelines (PCGs)
• Clinical Practice Guidelines (CPGs)
• ImmTrac2
• Quality Improvement (QI) Toolkit and Tip Sheets
• Texas Health Steps (THSteps) for Medical Providers

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

HEDIS is a registered trademark of NCQA.