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 PCP on an annual basis, following the end of quarter 4. For additional information refer to the 2021 CBI Technical Specifications.
CPT Codes: 83036, 83037
CPT II Codes: 3044F, 3046F, 3051F, 3052F
LOINC Codes: 17856-6, 4548-4, 4549-2
Telehealth Modifier Codes: GT, 95
Telehealth Place of Service Code: 02 (for non-FQHCs)
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)|
- 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 66 years of age and older at the end of the measurement year with frailty and advanced illness. See CBI Technical Specifications for more details.
- Members who had two visits related to for advanced illness.
- Members who were dispensed dementia medication.
- 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.
Data for this measure will be collected using laboratory data, provider data submissions via the Data Submission Tool on the Provider Portal, and claims.
- Run a report from your EHR system
- Manually compile patient data (Example: Download monthly breast cancer screening quality report on the Provider Portal and compare to EHR)
This measure allows providers to submit HbA1c test results from the clinic EMR/EHR system or paper records to the Alliance at the end of the measurement year by uploading data files to the Data Submission Tool on the Provider Portal. The files are required to be submitted as a CSV file to be accepted. A Data Submission Tool Guide is available on the Provider Portal to provide you with step-by-step instructions.
- Recommend lifestyle changes as appropriate.
- Enroll members into Alliance programs
- Live Better with Diabetes program covers diabetes education for all ages for tools for diabetes management.
- Diabetes Self-Management Program (DSMP) connects members diagnosed with diabetes up to 20.5 hours during initial 12 months following the diagnosis, and up to two hours of follow-up each year with pre-approved education providers (ex. Certified Diabetes Educators).
- 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 that have transportation challenges to the Alliance’s Transportation Coordinator at 1-800-700-3874 ext. 5577; this service is not covered for non-medical locations or 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 PharmacyAcademicDetailing@ccah-alliance.org.