Glaucoma Testing measure

Now that I'm done with vacation and happily(no more summer camp for a year) back at work let's get back to talking about HEDIS and Medicare. Let's talk about a particular measure, Glaucoma Testing. 

MEASURE: Glaucoma Testing
NUMERATOR: % of denominator who had at least 1 glaucoma exam by an eye Dr. during year or year prior
DENOMINATOR: Enrollees aged 67 or older without a prior diagnosis of glaucoma

This seems to be pretty straight forward but this can be very deceptive.  How many health plans get information from eye doctors? Most plans do pay for eye exams but a lot of members do pay out of pocket. Plus members may have supplemental insurance and programs that may be better than what the plan offers.  Plus not all the eye doctors take all insurance. So how the heck does a plan figure out how to increase this score?

You got a couple of different ways. You could have a proactive system where you engage the members get their eye doctors into your provider program.  You could just link up with a national eye insurance program and get them to send you their data.  The other option is HEDIS supplemental data.  This can be pretty tough for a Health Plan if they don't have a good outreach program in place.  If you are going to use supplemental you will need a clinician that will have to collect date, results, type of eye doctor and verify it has no exclusion.Plus you'll need to get this data collection signed off by your auditor.  Be prepared to have a lot of material available for review.