Diabetic HbA1c Poor Control >9% Tip Sheet
The percentage of members 18–75 years of age with diabetes (type 1 and type 2) with an HbA1c score of >9%. Members with no lab result submitted, claim without a HbA1c value or HbA1c value >9% will be considered non-compliant for this measure (A lower rate indicates better performance).
Incentives will be paid to the linked primary care provider (PCP) on an annual basis, following the end of Quarter 4. For additional information, refer to the CBI Technical Specifications.
Members who do not have a diagnosis of diabetes in any setting during the measurement year or the year prior and who had a diagnosis of gestational diabetes or steroid-induced diabetes, in any setting, during the measurement year or year prior.
Members in hospice or receiving hospice services or palliative care during the measurement year.
Members 66 years of age and older as of December 31 of the measurement year with frailty and advanced illness:
- At least one encounter for frailty during the measurement year.
- At least one of the following during the measurement year or year prior to the measurement period:
- At least two outpatient, observation, emergency department (ED) visits or non-acute inpatient encounter on a different date of service (DOS), with an advanced illness diagnosis. Visit types must be the same for the two visits.
- At least one acute inpatient encounter with an advanced illness diagnosis.
- Dispensed dementia medication.
CPT Codes: 83036, 83037
LOINC Codes: 17856-6, 4548-4, 4549-2
Telehealth Modifier Codes: GT, 95
Telehealth Place of Service Code: 02 (for non-Federally Qualified Health Centers)
CPT Category II codes are optional tracking codes that can be used for performance measurement, here defining the HbA1c range. They may not be used as a substitute for Category I codes.
|3044F||Most recent hemoglobin A1c (HbA1c) level less than 7.0% (DM)|
|3046F||Most recent hemoglobin A1c level greater than 9.0% (DM)|
|3051F||Most recent hemoglobin A1c (HbA1c) level greater than or equal to 7.0% and less than 8.0% (DM)|
|3052F||Most recent hemoglobin A1c (HbA1c) level greater than or equal to 8.0% and less than or equal to 9.0% (DM)|
Data for this measure is collected using claims, laboratory data, DHCS FFS encounter claims, and provider data submissions via the DST on the Provider Portal. To find gaps in data:
- Run a report from your electronic health record (EHR) system; or.
- Then manually compile patient data (Example: Download monthly diabetes care quality report or your Care-Based Incentives Measure Details report on the Provider Portal and compare to EHR/paper charts).
This measure allows providers to submit HbA1c test results from the clinic EHR system or paper records to the Alliance by the DST contractual deadline . To submit, you may upload data files to the DST on the Provider Portal. To be accepted, data must be submitted as a CSV file. Step-by-step instructions are available in the Data Submission Tool Guide on the Provider Portal.
- Perform A1C test every 3 months in patients whose therapy has changed or who are not meeting glycemic goals (≥0 HbA1c).
- Set appropriate individualized A1C goals based on relevant comorbidities, demographic factors and other considerations.
- Point-of-care testing for A1C provides the opportunity for more timely treatment changes.
- Recommend lifestyle changes as appropriate (e.g. stress management, exercise and better eating habits).
- Enroll members into Alliance Health Education and Disease Management Programs using the Health Education and Disease Management Program Referral Form.
- The Live Better with Diabetes program covers diabetes education for all ages and provides tools for diabetes management.
- The Diabetes Self-Management Education program (DSME) connects members diagnosed with diabetes with up to 20.5 hours of education during the initial 12 months following the diagnosis. The program also includes up to two hours of follow-up each year with pre-approved education providers (i.e. Certified Diabetes Educators).
- The Diabetes Prevention Program (CDC-DPP) is an evidence-based curriculum for members diagnosed with pre-diabetes that connects members to lifestyle coaches.
- Refer Alliance members to Care Management services, including Complex Case Management and Care Coordination, by calling Case Management at 800-700-3874, ext. 5512.
- Refer patients who have transportation challenges to the Alliance’s Transportation Coordinator at 800-700-3874, ext. 5577. This service is not covered for non-medical locations or for appointments that are not medically necessary.
- Academic detailing is an innovative, multi-faceted educational outreach method. We focus on clinical topics where gaps exist between evidence-based guidelines and typical practice patterns. The goal is for the detailer and provider to develop a trusted relationship where actionable, achievable goals are developed in alignment with best practices, all while addressing any applicable barriers. Academic detailing is available for Alliance providers. For more information, please email [email protected].