The prevalence of diabetes continues to rise in the United States, placing an increasing burden on healthcare systems, payers, providers, and patients. Left unmanaged, diabetes can lead to serious complications, including neuropathy, kidney disease, heart disease, blood pressure, and stroke. Among chronic diseases, diabetes has been a focus of quality performance measurement for many years, especially in value-based contracts. To assess quality of care, the Centers for Medicare & Medicaid Services (CMS), the National Committee on Quality Assurance (NCQA), and the American Diabetes Association (ADA) led the first national effort to develop a set of performance measures for diabetes. These quality performance measures have since been widely adopted for assessment in Medicare, Medicaid, and commercial health plans as a driver towards value-based care. Key quality measure indicators for monitoring and managing diabetes include:
- Glycemic Status Assessment for Patients with Diabetes (formerly Hemoglobin A1c1)
- Kidney Health Evaluation for Patients with Diabetes
- (Retinal) Eye Exam for Patients with Diabetes
- Statin Use in Persons with Diabetes
- Medication Adherence for Diabetes Medications
- Blood Pressure Control for Patients with Diabetes
1 Considered a Triple Weighted Measure in Medicare Advantage plans.
What is happening?
Every year, NCQA updates and releases the Healthcare Effectiveness Data and Information Set (HEDIS™). In addition, CMS updates Medicare Part C & D Star Ratings, many of which relate to diabetes care:
- Updated quality measure name from Hemoglobin A1 Control for Patients with Diabetes (HBD) to Glycemic Status Assessment for Patients with Diabetes (GSD)
- Added glucose management indicator (GMI) as an option to meet GDS care gap closure
- Updated method for identifying advanced illness in exclusions
- Clarified laboratory claims cannot be used for exclusions for certain palliative care, advanced illness, and frailty
Why is it important?
Hemoglobin A1c control remains a consistent quality measure across all value-based care programs, and therefore should be prioritized at health systems as part of patient outcomes and quality performance improvement initiatives. Providers and practices can utilize the below questions to evaluate current care, education, and financial workflows and identify gaps that need to be addressed:
- What is the best approach to achieve optimal clinical outcomes? At what A1c value(s) do we identify patients for outreach, intervention, and at what specified intervals for follow-up?
- What are the most efficient and effective methods for patient outreach and engagement?
- How do we integrate test results from specialty providers in primary care electronic health records (EHRs) effectively and accurately to accomplish discrete data capture for quality reporting?
- What key quality measure information should we integrate into provider education content, and in what way to cultivate provider engagement?
- How does the triple weight of this measure in some quality programs impact the overall performance score?
- How do we optimize data and analyze performance dashboards to prioritize tasks and guide strategy?
- For those in traditional Medicare Accountable Care Organizations (ACOs), how can we best prepare for the transition from CMS Web Interface Quality Measure (WIQM) reporting to electronic clinical quality measure (eCQM)/MIPS or Medicare CQM reporting for this and other measures beginning with the 2025 performance year?
How does this impact you?
Diabetes quality measures are integral components of value-based programs and population health initiatives. Governing bodies, such as CMS and NCQA, will continue to refine them to ensure performance remains relevant and effective. As payers emphasize quality measures as a means to improve clinical care and outcomes at lower cost, providers must be aware of the need to implement value-based care strategies. How is this accomplished?
- Know the changes and learn the specifics
- Identify a physician champion and engage the entire care team
- Build and refine processes
- Optimize quality data for reporting, prioritization, and focused strategies
- Outreach patients and connect them to the right care at the right place at the right time.
Achieving high performance in quality programs creates a path to success in value-based care, and diabetes measures are a good starting point for success.
Reference: 2024 UHC PATH Quality Reference Guide