October 28, 2022

To support quality care, we are providing information to providers and members to encourage discussions on health topics. Watch for more on health care quality in our News and Updates.

More than 37 million Americans–approximately one in eight–have diabetes, according to the Centers for Disease Control and Prevention (CDC). Because symptoms can develop slowly, one in five don’t know they have it. We encourage providers to talk with our members about diabetes, including:

• Type 1 and Type 2 diabetes symptoms
• Regular eye exams to avoid vision loss, or diabetic retinopathy
• Screenings for kidney disease, or diabetic nephropathy

Why Diabetes Care Is Important

If left unmanaged, diabetes can lead to serious complications. These may include heart disease, stroke, hypertension, blindness, kidney disease, diseases of the nervous system, amputations, and premature death. Providers play an important role in supporting our members through regular screenings, tests, and office visits. See our preventive care and clinical practice guidelines on diabetes and the CDC guidelines.

Closing Care Gaps

As part of monitoring and helping improve quality of care, we track Comprehensive Diabetes Care. Comprehensive Diabetes Care is a Healthcare Effectiveness Data and Information Set (HEDIS^®) measure from the National Committee for Quality Assurance (NCQA). This includes Blood Pressure Control for Patients with Diabetes (BPD), Eye Exam for Patients with Diabetes (EED), and Hemoglobin A1c Control for Patients with Diabetes (HBD). It applies to members ages 18 to 75 with diabetes (type 1 or type 2) who had the following during the measurement year:

• HbA1c poor control (>9.0%)
• HbA1c control (<8.0%)
• Retinal eye exam
• Blood pressure control (<140/90 mm Hg)
• Hemoglobin A1c (HbA1c) testing

In addition, we track Kidney Health Evaluation for Patients with Diabetes (KED). This is a HEDIS^® measure developed by NCQA with input from the National Kidney Foundation. It applies to our members ages 18 to 85 with diabetes (type 1 or type 2) who received a kidney health evaluation. An evaluation is defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR) during the measurement year.

Tips to Consider

• Identify care gaps and schedule lab tests before office visits to review results and adjust treatment plans if needed.
• Complete urine protein testing for attention to nephropathy at an office visit. Testing includes basic urinalysis by dip stick or tablet reagent.
• Document medication adherence to angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB) when applicable.
• Repeat abnormal lab tests later in the year to document improvement.
• Monitor blood pressure status at each visit and adjust medications as needed for control.
• Encourage members with diabetes to have annual retinal eye exams by an eye care specialist.
• Communicate with members and other treating providers to ensure all tests are completed and results are documented in the medical record.

Resources:

Reference and review the Blue Cross and Blue Shield of Texas (BCBSTX) Preventive Care Guidelines (PCGs), Clinical Practice Guidelines (CPGs), and Texas Health Steps THSteps for Medical Providers, which includes all current vaccine schedules, ImmTrac2 and other important guidance for treating your patients.

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. Use of this resource is subject to NCQA’s copyright.  The NCQA HEDIS measure specification has been adjusted pursuant to NCQA’s Rules for Allowable Adjustments of HEDIS. The adjusted measure specification may be used only for quality improvement purposes.