Annual wellness visits (AWVs) are an important part of holistic preventative care. These visits are generally a longer appointment than the typical annual exam. This extra time allows the provider to address open quality care gaps, discuss patient concerns that they may not have had a chance to cover during the regular physical exam, reconcile medications, and have more in-depth two-way dialogue with patients about potential barriers to care, challenges, and social factors that may impact their overall health. If your practice does not currently conduct outreach to schedule eligible members for an AWV, this may be an opportunity to increase quality performance and PCP Quality Incentive Program (PQIP) earnings by engaging with members outside of their annual exams. BCBSRI Medicare members are covered AWVs at no cost.
Screenings for members with diabetes
BCBSRI’s PQIP program currently includes three diabetes-specific HEDIS measures that encompass important aspects of monitoring in patients with diabetes.
- Glycemic Status Assessment for Patients with Diabetes (GSD)
- Kidney Health Evaluation for Patients with Diabetes (KED)
- Eye Exam for Patients with Diabetes (EED)
If your practice utilizes an electronic medical record system, instituting an order set or workflow within the EMR to address all aspects of diabetic monitoring may reduce the number of missed opportunities in each of these measures. It may also ease the mental load providers often face when addressing diabetic care during an already busy appointment where members likely have many concerns or questions about their overall health.
Important parameters for diabetic screenings:
- Glycemic status assessment:
Members with diabetes (types 1 and 2) whose most recent glycemic status (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) was at the following levels during the measurement year:
- Glycemic status < 8.0% (Commercial)
- Glycemic status < 9.0% (Medicare)
- Kidney health evaluation:
Members with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by:
- An estimated glomerular filtration rate (eGFR)
AND
- A urine albumin-creatinine ratio (uACR), during the measurement year
- Retinal eye exam:
Members with diabetes (type 1 and type 2) who had one of the following:
- A retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in 2024
- A negative retinal or dilated eye exam (negative for retinopathy) by an eye care professional in 2023
Gap in care reports – health equity focus
BCBSRI has enhanced monthly gap-in-care reporting to align with our mission to decrease disparities in health equity across our member population. You can find health equity identifiers to inform your approach to addressing gaps in care with your patients in columns AZ-BF on the detail report.
Health equity indicators:
- Race: The race assigned to a member
- Ethnicity: The ethnicity assigned to a member
- Disability: Member is identified to have a disability
- Dual_CMS_Eligible: Members eligible to be in dual CMS population
- RI_DSNP_Eligible: Subset of dual CMS population; in Rhode Island DSNP population
- LIS_Eligible: Members who are eligible for low-income status
- Combo: Members who are eligible for low-income status and disability
As always, the Quality Concierge team is available to answer any questions you have. Please reach out to QualityHEDIS@bcbsri.org.