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 75^th 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.

Learn about HSCSN’s Diabetes Performance Improvement Project and related HEDIS measure

Upcoming changes for HEDIS MY 2022

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: