HEDIS for Diabetes
Date: 01/14/19
More than 100 million Americans have diabetes or prediabetes. Left untreated, the condition can lead to heart disease, stroke, hypertension, blindness, diseases of the nervous system, amputations, and death. Providers can help members manage their condition and control their glucose levels by prescribing medications and recommending lifestyle changes, such as eating a healthy diet, getting sufficient exercise and quitting smoking.
The Healthcare Effectiveness Data and Information Set (HEDIS®) measures for diabetes include:
- Comprehensive diabetes care.
- Diabetes screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications.
- Diabetes monitoring for people with diabetes and schizophrenia.
- Statin therapy for patients with diabetes.
Tests for diabetics
The HEDIS measure for comprehensive diabetes care, directed to patients ages 18 to 75 who have type 1 or type 2 diabetes, lists the following tests and exams:
- HbA1c testing. Completed at least annually.
o HbA1c result > 9 = poor control
o HbA1c result < 8 = in control
- Dilated retinal eye exam. Performed in the previous two years.
- Medical care for nephropathy. At least one of the following: nephropathy screening, ACE/ARB therapy or documented evidence of nephropathy.
- Blood pressure. Lower than 140/90 mm Hg is considered in control.
The National Committee for Quality Assurance (NCQA) provides a Diabetes Recognition Program to recognize providers who use HEDIS measures to care for their patients with diabetes. To learn more about the program, go to the NCQA website.