Health Indicator Report of HEDIS (Healthcare Effectiveness Data and Information Set) Measures: Diabetes Care - Hemoglobin A1c (A1C)

This Indicator Report contains information about Medicaid Health Maintenance Organizations (HMOs), commercial HMOs, and commercial Preferred Provider Organizations (PPOs). 2013 was the first year that PPOs were been included in this report and represents a significant expansion of the report's scope. With the inclusion of PPOs to the other plans, over 50% of Utahns who currently have health insurance are covered by one of the health plans in this report.

Notes

This quality of care measure Indicator Report came from the Healthcare Effectiveness Data and Information Set (HEDIS), which is developed and maintained by the National Committee for Quality Assurance (NCQA). The HEDIS measurement set contains over 70 measures across eight major areas of care such as helping people stay healthy or caring for people with chronic illness. Health plans nationwide collect these measures to see how they performed in different areas of health care over the past year. Each year, Utah HMOs report HEDIS measures to the Utah Department of Health. All data are reviewed by NCQA-certified auditors to ensure that the reported HEDIS measures are representative and accurate. The National Committee for Quality Assurance (NCQA) is a non-profit organization committed to assessing, reporting on, and improving the quality of care provided by the nation's health plans.

Data Source

Healthcare Effectiveness Data and Information Set (HEDIS), National Center for Quality Assurance (NCQA)

Data Interpretation Issues

Evidence from health plan administrative records and survey interviews indicates that the American Association of Diabetes Educators (AADE) and the National Committee for Quality Assurance (NCQA) surveys might substantially underestimate the proportion of persons with diabetes who have a routine A1C test. Note that starting in 2017, Utah commercial HMOs and PPOs are now regarded as functionally the same and are used together in calculating the state averages.

Definition

Percentage of health plan members with diabetes who had their Hemoglobin A1c tested within the last year.

Numerator

Number of sampled health plan members with diabetes who had their Hemoglobin A1c tested within the last year.

Denominator

Number of sampled health plan members with diabetes.

Healthy People Objective D-11:

Increase the proportion of adults with diabetes who have a glycosylated hemoglobin measurement at least twice a year
U.S. target: 71.1 percent

How Are We Doing?

The American Diabetes Association recommends an A1C exam about every three months.

What Is Being Done?

The Diabetes Prevention and Control Program has been combined with the Heart Disease and Stroke Program, the Physical Activity, Nutrition and Obesity Program, and a School Health Program. The new program is known as the Healthy Living through Environment, Policy, and Improved Clinical Care (EPICC) Program. One of EPICC's main goals is to decrease the proportion of people with diabetes who have A1Cs greater than 9%. A number of studies show that people who attend diabetes self-management education classes have lower A1C levels. These classes are usually taught by a dietitian, pharmacist, or certified diabetes educator, and have been shown to help individuals develop a variety of skills, including blood sugar monitoring, they need to manage their diabetes. A list of classes is available at [https://livingwell.utah.gov/program.php?grp=diab].

Available Services

Diabetes Self-Management Education (DSME) [https://livingwell.utah.gov/program.php?grp=diab]