Quality Focus

2021 Opportunities in Diabetes A1c and BP Control Measures

Quality performance in 2021 presents many challenges but opportunities for improving as well. The NEPHO’s 4 largest commercial contracts continue to emphasize “outcomes” measures, i.e. those measures which are results based as opposed to claims based. There are 3 outcomes measures:

  • Diabetes A1c Control
  • Diabetes BP Control
  • Hypertension Controlling Blood Pressure (<140/90)

This article will identify opportunities for improved performance in the 2 Diabetes outcomes measures. According to the most recently received payer extracts for BCBS HMO & PPO, HPHC & THP, across the NEPHO there are 702 patients who have been identified as having diabetes and are in the Diabetes outcomes measures.

Harvard Pilgrim and Tufts Health Plan measure performance against the HEDIS 90th percentile. The HEDIS 90th percentile rates quality performance in relation to other organizations on a national level. Although the HEDIS performance threshold varies annually based on national performance rates, the performance thresholds would be similar to those for Blue Cross. Blue Cross HMO & PPO measure performance based on thresholds set by Blue Cross.

The Blue Cross minimum and maximum thresholds for the DM Blood Pressure Control measure increased slightly in 2021. Blue Cross also “weighs” the outcomes measures higher than the claims based process measures. As of 2021, Blue cross outcomes measures will be weighted 5x the Blue Cross process measures. Combined with a decrease in the number of process measures from 19 to 8 for 2021, Blue Cross is increasing emphasis on results based measures rather than claims based measures.

The Northeast PHO strives to be among the top performers in the BILH Performance Network and BILH system in Quality. As always, it is challenging to meet the high thresholds set by the insurance plans but there are many opportunities for improvement.

  • There are currently 103 patients whose last A1c was above the measure target (</=9.)
  • Of those 103 patients, 38 have not yet had an A1c in 2021.
  • Of these same 103 patients, 32 also have a last blood pressure reading above target (<140/90), 11 of which were taken prior to 1/1/21.

What will the NEPHO Quality Team do to help you meet our Quality goals?

  • Our data analysts will work closely with your office manager and quality contacts to identify patients who need an appointment and/or labs.
  • Our Nurse Case Managers will work directly with your patients to support them in managing their diabetes, encouraging adherence to medications and making healthier lifestyle choices.
  • Our Population Health team will continue to identify quality care gaps for providers by entering pre-visit planning notes for diabetes patients with scheduled visits. The PVP pilot is with Epic practices only at this time with plans to expand to non-Epic practices in 2021.

What can you and your practice do to help optimize the NEPHO Quality performance in 2021? Below are some suggestions:

  • Schedule an appointment for anyone who has not yet had a blood pressure reading in 2021. Patients with digital home blood pressure monitors may report their BP reading during a virtual visit with a provider.
  • Order an HBA1c for any patient who does not yet have a result in 2021.
  • Review diabetes related medications and attempt to establish a routine of regular follow up appointments for those patients with results above the targets for A1c and BP control.
  • Take a second blood pressure if the first is 140/90 or greater.

Please contact anyone on the Quality Team with questions about the Diabetes outcomes or other Quality measures.