Skip to main content

Attention! Nationwide recall of certain apple sauce pouches due to possible contamination with lead. Learn more.

Effective July 15th, Health Services for Children with Special Needs (HSCSN) will implement Optum Financial/Optum Pay as the check payment vendor for provider electronic funds transfer (EFT). The details to the provider letter can be found in this document.

Diabetes Performance Improvement Project

HSCSN Diabetes Performance Improvement Project (PIP)

  • Health Services for Children with Special Needs, Inc. (HSCSN) is the contracted health care plan provider for the District of Columbia’s Child and Adolescent Supplemental Security Income Program (CASSIP) for children and young adults.
  • Each PIP has performance measures on which progress is evaluated.
  • The National Committee on Quality Assurance (NCQA) uses Healthcare Effectiveness Data and Information Set (HEDIS) measures to evaluate the quality of health plans.
  • HSCSN is currently participating in a PIP related to diabetes care.  The purpose of a PIP is to improve the quality of care provided to enrollees 18 years and older with diabetes.   The Diabetes PIP specifically is focused on the Comprehensive Diabetes Care (CDC) HEDIS measure, with a goal of achieving at least the 75th percentile on each CDC sub-measure. 

HEDIS Measures and Care Gaps

HEDIS assists providers in identifying and eliminating gaps in care for the patients assigned to their panel. For more information, please contact Davina Green, HEDIS Manager, at: (202) 308-4617 or Dgreen@hschealth.org.

Diabetic Healthcare and Effectiveness Information Set (HEDIS) Performance Measures

The HEDIS measure for Comprehensive Diabetes Care (CDC)-Blood Glucose Control for people 18 to 75 years of age and over assesses whether or not each enrollee has the following tests or screenings annually:

  • HbA1C Test 
  • Retinal Eye Exam
  • Screening for evidence of blood pressure control (based on most recent reading).

The completion of the following metrics would bring the enrollee into compliance with the Diabetes HEDIS Performance measure.

Comprehensive Diabetes Care (CDC) - The percentage of enrollees 18-75 years of age with diabetes (type 1 and type 2) who had each of the following during the measurement year:

  • Performance Measure 1: Hemoglobin A1c (HbA1c) Testing
  • Performance Measure 2: HbA1c poor control (>9.0%)
  • Performance Measure 3: HbA1c control (<8.0%)
  • Performance Measure 4: HbA1c Control (<7%) for a Selected Population – MY2020 Retired the “HbA1c Control (<7%) for a Selected Population” indicator for the commercial and Medicaid product lines
  • Performance Measure 5: Eye Exam (Retinal) Performed
  • Performance Measure 6: Medical Attention for Nephropathy – MY2020 Retired the “Medical Attention for Nephropathy” indicator for the commercial and Medicaid product lines (* See KED measure below)
  • Performance Measure 7: Blood Pressure Control (< 140/90 mm Hg)

 

Kidney Health Evaluation for Patients with Diabetes (KED)*

The percentage of enrollees 18–85 years of age with diabetes (type 1 and type 2) who received a kidney health evaluation, during the measurement year.

Kidney Health Evaluation:

Enrollees who received both of the following during the measurement year on the same or different dates of service:

  • At least one eGFR (Estimated Glomerular Filtration Rate).
  • At least one uACR identified by both a quantitative urine albumin test (Quantitative Urine Albumin Lab Test) and a urine creatinine test (Urine Creatinine Lab Test) with service dates four or less days apart.

For example, if the service date for the quantitative urine albumin test was December 1  of the measurement year, then the urine creatinine test must have a service date on or between November 27 and December 5 of the measurement year.

For Comprehensive Diabetes Care Compliance, the following tests are required:

  • Hemoglobin A1c (HbA1c) testing; HbA1c control (<7.0%
  • LDL-C: fasting blood test; goal < 100 mg/dL
  • Eye exam (retinal) performed by ophthalmologist or optometrist
  • BP control (<140/90 mm HG

Clinical Practice Guidelines 

Online Diabetes CME Resources

HSCSN has curated the most up to date diabetes trainings and activities for our providers. Please click on the training links below.

1. Practical Approaches to Addressing Common Clinical Situations

          Released: September 30, 2020

          Expires: September 30, 2021

2. Challenges to Continuous Glucose Monitoring (CGM) Adoption and Use

         Released: September 30, 2020

         Expires: September 30, 2021

3.  Are You Addressing Hypoglycemia in Your Patients with Diabetes?

         Released: May 4, 2021

         Expires May 4, 2022

4.  Moving Targets – The Importance of Communication in Pediatric CGM

         Released: April 13, 2021

         Expires: April 13, 2022

5.  Moving Targets – Revisiting the Pediatric patient on CGM

         Released: April 21, 2021

         Expires: April 21, 2022

Diabetes Health Education for Enrollees 

Handouts

  1. HSCSN Diabetes Booklet [PDF] »
  2. 4 Steps to Managing your Diabetes for Life [PDF - English]»
  3. 4 Steps to Managing your Diabetes for Life [PDF - Spanish] » 

Self-Management Programs

  1. DC DOH Living Well Self-Management Workshops
    1. Living Well Self-Management course overview 
    2. Living Well Self-Management course FAQs
  2. MedStar Washington Hospital Center
  3. Children's National Medical Center Diabetes Program (Childhood and Adolescent)