In 2024, the National Committee for Quality Assurance (NCQA) revised the name of the HEDIS measure, "Hemoglobin A1c Control for Patients With Diabetes (HBD)" to "Glycemic Status Assessment for Patients With Diabetes (GSD)." This change added the glucose management indicator (GMI), which calculates continuous glucose monitoring (CGM) data using average glucose levels.
Figure 1 provides an overview of the key differences in the two measurements. The GSD:
- Assesses the glycemic status control in patients aged 18–75 with type I & II diabetes
- Includes both hemoglobin (HbA1c) and glucose management indicator (GMI) values with targets of:
- Good Control: HbA1c or GMI < 8.0%
- Poor Control: HbA1c or GMI > 9.0%
- Uses medical and pharmacy claims data to identify patients
Figure 1. Comparing HbA1c and GMI
KEY UPDATES
- HbA1c in the HEDIS measure is now stated as “glycemic status” with a glycemic status goal <8%.
- Continuous glucose monitor GMI results can now be used in addition to HbA1c.
- LOINC code 97506-0 is used to identify GMI values in the chart and must include:
- Documentation of the continuous glucose monitoring including a result
- Date range associated with the GMI. The end date of the range is used for the assessment date.
- Results from the most recent glycemic status assessment (HbA1c or GMI) performed during the measurement year will count towards compliance.
BEST PRACTICE TIPS:
- Test A1c 2 to 4 times annually and provide education on lab results, adjusting treatment plans as needed.
- Follow-up with patients whose A1c >8% for re-testing every 3 months.
- Use clinic gap reports to track patients with A1c > 8%, and recall those members for GMI or A1c checks every 3 months.
- Set care gap alerts in your electronic medical record when screenings are due.
- Outreach to patients who have not had their diabetic testing and eye exams completed.
- Document HbA1c or GMI result date and numeric value in the medical record. Ensure that:
- A1c results include date collected OR reported AND numeric results.
- CGM results include EITHER:
- 14-day CGM date range (terminal date used as assessment date) AND GMI numeric result OR
- An upload of 14-day CGM data report (for QPP participating clinics only).
- Incorporate a GMI workflow to assess blood sugar control for those who use a CGM.
- Remember to include CPT II HbA1c codes to help reduce the burden of HEDIS medical record chart review.
- Use the codes shown in Figure 2 on the date of service the HbA1c was drawn. If using an electronic health record (EHR) system, please consider electronic data sharing with Select Health to help us capture the glycemic status values. This will help reduce HEDIS chart requests and improve the quality of care we can provide our members. If interested, please email us at qualityimprovement@selecthealth.org.
Figure 2. CPT II HbA1c Codes
WHAT DOES CORRECT DOCUMENTATION LOOK LIKE?
Figures 4 and 5 illustrate examples of correct documentation for the GMI measure.
Here, you can see the documentation notes that the monitor was worn consistently over a 14-day period, and there is a box around the July 3rd terminal date. The provider note says that the GMI for the “last 2 weeks” is 8.5%. In this case, we would use the office visit date as the GMI result date; the Glucose Management Indicator (GMI) is 5.9%.
This example in Figure 5 has the 14-day date range in the note as well as the GMI result. The terminal date is the last date in that 14-day date range and is December 4. If there is an A1c and GMI on the same day, Select Health can accept the lower one. The latest one taken in the year is what will count towards the measure.
Remember, documentation requirements include:
- The CGM has to be worn continuously for at least 14 days.
- Select Health needs the "terminal date," which is the last date in that 14-day continuous monitoring period and the numeric GMI result.
- There is now a correction option in the Quality Data Corrections Tool for GMI (for QPP participating clinics only).
REFERENCE:
1. Selvin E. The glucose management indicator: Time to change course? Diabetes Care, 2024. 47(6), 906-914