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:
- Hemoglobin A1c (HbA1c) Control1
- Kidney Disease Monitoring/Medical Attention for Nephropathy
- Retinal Eye Exam
- Statin Use in Persons with Diabetes
- Medication Adherence for Diabetes Medications1
- Blood Pressure Control
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. Measurement Year 2022 changes include the following, many of which relate to diabetes care:
- HbA1c testing, antibiotic utilization, advanced care planning indicator, and nephropathy were retired.
- Kidney Health Evaluation for Patients with Diabetes (KED) measures were added, replacing nephropathy.
- Race and ethnicity stratifications were introduced to five measures: Colorectal Cancer Screening, Controlling High Blood Pressure, Hemoglobin A1c Control for Patients with Diabetes, and Prenatal and Postpartum Care
- NCQA separated one indicator into three standalone measures:
- Hemoglobin A1c Control for Patients with Diabetes with indictors for HbA1c Control <8 and Poor Control HbA1c >9,
- Eye Exam Performed for Patients with Diabetes, and
- Blood Pressure Control for Patients with Diabetes.
Why is it important?
Hemoglobin A1c control remains a consistent measure across all payer quality programs and therefore should be prioritized at health systems in 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 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 CQM reporting for this and other measures?
How does this impact you?
Diabetic measures are not going anywhere. 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 better care at lower cost, providers must be aware of the need to implement value-based care strategies to perform well. 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 diabetic measures are a good starting point for success.