QUALITY IMPROVEMENT & PATIENT CARE
HOW PROVIDERS CAN HELP IMPROVE DIABETIC MEMBERS' GLYCEMIC STATUS
SUMMARY: Recent quality scores show there’s still room to improve glycemic status for members with diabetes. Routine A1c testing,—along with proper documentation and coding—helps drive better care and outcomes. See this year’s performance and how you can help.
HELPING IMPROVE DIABETES OUTCOMES
Everyone wants the best health outcomes for members with diabetes. Whether they have Type 1 or Type 2 diabetes, people with diabetes are at risk for serious health complications, including kidney disease, cardiovascular conditions, and nerve damage. To monitor this risk and facilitate early intervention and effective management, routine A1c testing, which provides a snapshot of a member’s average blood glucose levels over the past two to three months, is recommended by both state and federal health agencies. The National Committee on Quality Assurance (NCQA) assesses health plans and providers annually to ensure critical quality measures, including regular A1c testing, are being encouraged, performed, and properly documented.
Quality scores in 2024, the most recent results available, indicate significant opportunities to improve the glycemic status of diabetic members. Our measures across the various lines of business show the following compliance rates for eligible members:
| Eligible Members with Glycemic Status <8% | 2022 | 2023 | 2024 |
|---|---|---|---|
| Healthy U Medicaid | 55.96% | 59.85% | 67.88% |
| Healthy U Integrated | 54.50% | 60.34% | 67.40% |
| U of U Health Plans Individual and Family plans | 69.78% | 68.18% | 72.26% |
| U of U Health Plans Commercial Group plans | 65.24% | 65.38% | 65.80% |
Our members, and all of your patients with diabetes, need your help to achieve the best outcomes. A1c testing may be performed in primary care settings, labs, or endocrinology offices. However, in some cases, the test may not be documented correctly in the medical record or the claim may not clearly indicate the diagnosis of diabetes or the purpose of the test. This can result in the test not being counted toward the glycemic status quality measure.
HOW CAN PROVIDERS HELP MEMBERS IMPROVE GLYCEMIC STATUS
Please ensure that A1c tests are ordered and conducted routinely and that appropriate documentation and coding are used to capture both the diabetes diagnosis and the A1c test performed. Adjust care plans based on glycemic control to support long-term health. As their trusted Provider, your proactive efforts in testing and documentation are essential to achieving better outcomes.
Thank you for your continued commitment to excellence in diabetes care.