The cost of healthcare has continued to increase for many Americans over the past few decades. The total cost of diabetes to the U.S. healthcare system in 2017 amounted to $327B.2
In an effort to reduce healthcare costs we are starting to see a shift from a fee-for-service payment system to value-based care. There are many value-based programs out there – Medicare Advantage, MACRA, MIPS, MSSP, Direct Contracting, etc. These programs have measures that are associated with many providers’ performance and payment such as HEDIS, CAHPS, bundled payments, readmission rates, HOS, etc.
Patients with diabetes need prompt diagnosis along with ongoing monitoring and care as diabetes is associated with a variety of complications such as heart disease, stroke, nephropathy, and retinopathy to name a few.
One of the key HEDIS measures selected by providers are measured by is HbA1c control for patients with diabetes which can have a significant impact on patient outcomes, cost, quality, and improving health equity. Here we’ve shown the HEDIS measure that includes HbA1c testing, in an effort to provide a better understanding of why it’s such an important measure.
Assesses adults 18–75 years of age with diabetes (type 1 and type 2) who had each of the following:
1. Terhune, C, Respaut, R and Nelson, DJ, ‘Out of Control: America’s Losing Battle with Diabetes’. Reuters Investigates, 12 Aug 2021, accessed 2 June 2022, https://www.reuters.com/investigates/special-report/usa-diabetes-covid
2. Statistics About Diabetes, 4 Feb 2022, accessed 2 June 2022, https://www.diabetes.org/aboutus/statistics/about-diabetes
3. United States Food Inflation - May 2022 data, n.d., accessed 2 June 2022, https://tradingeconomics.com/united-states/food-inflation
4. Walsh, O, ‘Food Deserts: What They Are and What Causes Them’, Human League, 21 Feb 2022, accessed 2 June 2022, https://thehumaneleague.org/article/food-desert
5. ’Missouri is the #8 state with the most rural hospital closures since 2005’, ABC17news, 9 Dec 2021, accessed 2 June 2022, https://abc17news.com/stacker-missouri/2021/12/09/missouri-is-the-8-statewith-the-most-rural-hospital-closures-since-2005/#:~:text=Since%202005%2C%20181%20rural%20hospitals,Care%20Act%2C%20or%20the%20ACA
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8. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); 2017 Jan 11. 3, The Root Causes of Health Inequity. Available from: https://www.ncbi.nlm.nih.gov/books/NBK425845/
9. Gerald Reaven Obituary, The Lancet, 28 Apr 2018, accessed 31 May 2022, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30906-1/fulltext
10. Gerald Reaven, scientist who coined ‘Syndrome X,’ dies at 89, Stanford Medicine News Center, 20 Feb 2018, accessed 31 May 2022, <https://med.stanford.edu/news/allnews/2018/02/gerald-reaven-stanford-scientist-who-coined-syndrome-x-dies-at-89.html
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