Healthcare Effectiveness Data and Information Set (HEDIS) is a set of performance measures widely used in the United States to evaluate the quality of health care. Compliance with HEDIS measures is crucial for assessing and benchmarking the quality of services provided by health plans, state medicaid programs, and other organizations. Meeting HEDIS requirements involves collecting and reporting data on a set of standardized performance measures that cover various aspects of healthcare, including preventive care, chronic disease management, and member satisfaction.

What is Comprehensive Diabetes Care? 

HEDIS measures offer guidelines for Comprehensive Diabetes Care (CDC) for patients 18 to 75 years of age with diabetes type 1 and type 2. Providers can oversee much of this care in a remote setting. 

HEDIS guidelines encourage providers to monitor the following: 

• Hemoglobin A1c (HbA1c) testing 
• Retinal eye exam
• HbA1c poor control (>9.0%) 
• Medical attention for nephropathy
• HbA1c control (<8.0%) 
• Blood pressure control (<140/90 mm Hg)

Without proper management, diabetes can result in severe complications such as heart disease, stroke, hypertension, blindness, kidney disease, nervous system disorders, amputations, and premature death. Effective diabetes management is crucial for regulating blood glucose levels, minimizing the likelihood of complications, and extending patient lifespan. Through collaboration with healthcare providers, patients can successfully manage diabetes by adhering to medication instructions, adopting a nutritious diet, engaging in regular physical activity, and quitting the use of tobacco products.

HbA1c Control

Assessing average blood glucose is a vital aspect of diabetes management. Regular monitoring of average blood glucose levels plays a key role in mitigating the risk of enduring complications associated with diabetes, including nerve damage, kidney disease, and cardiovascular issues. HEDIS guidelines encourage providers to offer documentation in the medical record that includes a note indicating the date when the HbA1c test was performed and the result or finding. 

HbA1c testing is possible beyond traditional medical settings and can be conducted in the convenience of a patient's home. Using a dried blood spot card, patients can remotely conduct an HbA1c test. The process involves a physician ordering a self-collection kit, which is then sent to the patient's home following a telehealth or in-person office visit or as part of regular medical assessments.

Chat with Ash Wellness about at-home diagnostic testing for HbA1c.

Regular Eye Exams

Diabetes can damage the small blood vessels in the retina, a condition called diabetic retinopathy. It remains the leading cause of blindness among working-age U.S. adults, but regular screening and treatment prevent 90% of blindness. HEDIS measures recommend patients have a retinal or dilated eye exam from an optometrist or ophthalmologist in the measurement year or a dilated eye exam that is negative for retinopathy in the year prior to the measurement year. 

The American Telemedicine Association (ATA) and Ocular Telehealth Special Interest Group established guidelines for diabetic retinopathy telescreening. Ophthalmology is highly visual and image intensive, making it well suited for telemedicine and tele-screening. Providers can screen patients for diabetes and meet HEDIS requirements with remote tools, such as fundus pictures obtained in a nonmydriatic digital retinal camera that are then transmitted through the internet. 

Blood Pressure Control

Controlling blood pressure is important for preventing cardiovascular complications associated with diabetes. Lifestyle changes play a significant role in managing blood pressure. These include maintaining a healthy diet, engaging in regular physical activity, managing stress, limiting alcohol intake, and avoiding tobacco products.

HEDIS measures recommend that providers identify the most recent blood pressure reading taken during an outpatient visit, telephone visit, or virtual check-in, or through remote monitoring during the measurement year. Remote monitoring for blood pressure involves the use of technology to track and transmit blood pressure data from a patient's location to a healthcare provider without the need for in-person visits.

Conclusion on HEDIS requirements for diabetes 

The Comprehensive Diabetes Care (CDC) guidelines within HEDIS emphasize the importance of regular monitoring and control of various parameters, including HbA1c levels, eye exams, and blood pressure. With the advent of remote tools and telehealth, patients now have the convenience of conducting HbA1c tests at home. Telemedicine, particularly in the screening of diabetic retinopathy, demonstrates great potential in meeting HEDIS recommendations, ensuring early detection and prevention of complications. Moreover, the incorporation of remote monitoring for blood pressure aligns with lifestyle modifications, promoting patient engagement and proactive management.