HEDIS^® Tip Sheet

Medical Records should include

• A note indicating the date when the HbA1c test was performed and the result.
• Ranges and thresholds do not meet criteria. There must be a numeric value. 

Best Practices

• Inform patients of the North Dakota Diabetes Prevention and Control Program resource.
• Ensure HbA1c and other labs are ordered prior to patient appointments.
• Consider referral to diabetic educator or nutritionist.
• Educate patients on the importance of their annual diabetic eye exam, completing lab work and screenings.
• Evaluate and document HbA1c every three to six months.
• Remind patients to bring logbooks or glucose monitors to their appointment.
• Collect and review glucose management indicator [GMI] results during appointments
• Ensure to add lab values and GMI results to the EMR
• Outreach to patients with sub-optimal HbA1c.
• Care coordination with other providers caring for the patient.
• Ensure patient understands education materials with new onset diabetes.
• Set up a tracking mechanism within your healthcare system to identify gaps in care. Utilize EHR flags and reporting to assist in tracking patients in need of follow-up visits and those who cancel or do not show up for appointments so appropriate outreach can be made.

Notes

Glycemic status can be either hemoglobin A1c [HbA1c] or glucose management indicator [GMI] results

• Most recent glycemic status assessment of the year is used
• If multiple glycemic status assessments are on the same date, the lowest result is used
• GMI results collected by the member and documented in the member’s medical record are eligible for use in reporting as long as date or date range is indicated
• The HbA1c Poor Control rate is part of the BlueAlliance and BlueAlliance Care+ Program.
• This measure requires a record of glycemic status assessment value.  If a glycemic status result is missing or it was not completed during the measurement year, the member is numerator compliant for HbA1c Poor Control.
• A lower rate for glycemic status indicates better performance.
• Members are included in the denominator by meeting one of the following criteria:
  • Members with two diagnoses of diabetes on different dates of service during measurement year and year prior.
  • Members with a diagnosis of diabetes and dispensed insulin or hypoglycemics/ antihyperglycemics during the measurement year or the year prior to the measurement year.

Exclusions

• Members in hospice during the measurement year.
• Members who received palliative care during the measurement year.
• Members who died during the measurement year.
• Members 66+ years of age with frailty and advanced illness.  Members must meet BOTH the frailty and advanced illness criteria to be excluded:
  • At least two indicators of frailty with different dates of service during the measurement period. 
  • Any of the following during the measurement year or the year prior to the measurement year:
    • At least two outpatient visits, observation visits, ED visits, telephone visits, e-visits, or virtual check-ins, nonacute inpatient encounters, or nonacute inpatient discharges on different dates of service with an advanced illness diagnosis.
    • At least one acute inpatient encounter with an advanced illness diagnosis.
    • At least one acute inpatient discharge with an advanced illness diagnosis on the discharge claim.
  • A dispensed dementia medication.