05/20/2024
About 38 million Americans have diabetes, according to the Centers for Disease Control and Prevention. Because symptoms can develop slowly, one in five of them don’t know they have it. You may play an important role in supporting our members through regular screenings, tests and office visits.
Monitoring Our Members’ Care
We track Healthcare Effectiveness Data and Information Set (HEDIS®) measures from the National Committee for Quality Assurance related to diabetes care, including:
Hemoglobin A1c Control for Patients with Diabetes captures the percentage of our members ages 18 to 75 with diabetes (type 1 and type 2) whose HbA1c level during the measurement year is:
- Less than 8.0%, indicating controlled
- Greater than 9.0%, indicating uncontrolled. A lower rate on this measure indicates better performance
Eye Exam for Patients with Diabetes tracks members ages 18 to 75 with diabetes (type 1 and type 2) who have a retinal eye exam by an eye care professional to screen or monitor for diabetic retinal disease.
Blood Pressure Control for Patients with Diabetes captures members ages 18 to 75 with diabetes (type 1 and type 2) whose blood pressure was controlled (<140/90 mm Hg).
Kidney Health Evaluation for Patients with Diabetes tracks members ages 18 to 85 with diabetes (type 1 and type 2) who received a kidney health evaluation during the measurement year. An evaluation includes a blood test for kidney function (estimated glomerular filtration rate) and a urine test for kidney damage (urine albumin-creatinine ratio).
Statin Therapy for Patients with Diabetes tracks members ages 40 to 75 who have diabetes and do not have clinical atherosclerotic cardiovascular disease, and who received and adhered to statin therapy.
Tips to Close Gaps in Care
- Identify care gaps and schedule lab tests before office visits to review results and adjust treatment plans if needed.
- Monitor blood pressure status at each visit and adjust medications as needed for control.
- Document medication adherence to angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers when applicable.
- Repeat abnormal lab tests later in the year to document improvement.
- Encourage members with diabetes to have annual retinal or dilated eye exams by an eye care specialist.
- For our members on statin therapy, discuss the proper dose, frequency and the importance of staying on the medication.
- Communicate with members and other treating providers to ensure all tests are completed and results are documented in the medical record.
Resources
Information on Current Procedural Terminology (CPT®) Category II codes is available in Availity® Essentials in Payer Spaces in the Resources section. It includes information on coding for HbA1c Control for Patients with Diabetes and Blood Pressure Control for Patients with Diabetes.
We’ve created information that may help you discuss diabetes with our members.
Additional Resources
- Preventive Care Guidelines
- Clinical Practice Guidelines
- ImmTrac2 Texas Immunization Registry
- Quality Improvement Toolkit and Tip Sheets for Medicaid providers
- Texas Health Steps 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.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.