Encourage Annual Eye Exams and Statin Therapy Adherence for Members With Diabetes 

Oct. 13, 2026

We track the following Healthcare Effectiveness Data and Information Set (HEDIS®) measures from the National Committee for Quality Assurance related to diabetes care to identify and close gaps in care. 

Eye Exam for Patients with Diabetes captures the percentage of our members ages 18 to 75 with type 1 or type 2 diabetes who have a retinal eye exam by an eye care professional during the measurement year to screen or monitor for diabetic retinal disease.

The American Diabetes Association recommends regular diabetic retinal examinations for all individuals with diabetes. Those with any level of diabetic retinopathy should receive dilated retinal examinations at least annually, while individuals without retinopathy may be screened every 1 to 2 years if prior exams are normal and diabetes is well controlled.

Statin Therapy for Patients with Diabetes assesses the percentage of members ages 40 to 75 with diabetes who don’t have atherosclerotic cardiovascular disease and: 

  • Were dispensed at least one statin medication of any intensity during the measurement year
  • Remained on a statin medication of any intensity for at least 80 percent of the treatment period 

To help close care gaps, consider the following:

  • In early stages of retinopathy, people often don’t experience any symptoms. Discuss the importance of annual eye exams with our members who have diabetes, including members who are planning to be pregnant or are pregnant. We have information to share with members.
  • Build care gap alerts for eye exams in our members’ electronic medical records and send reminders.
  • Eye care specialists can support care coordination by communicating exam results to our members’ primary care providers
  • For members on statin medication, discuss the proper dose and frequency, and why it’s important to remain on the medication as prescribed. Consider converting their prescription to a 90-day supply through mail order or transferring it to a retail pharmacy to encourage adherence.
  • Discuss common side effects of statin use and what to do if our member has problems with the medication. Remind members to contact you if they think they’re experiencing side effects.
  • Review members’ medication profiles to confirm statin use history at follow-up appointments. Clearly document any diagnosis indicating an intolerance to statin therapy and any drug interactions with current medications.

Resources

  • See our preventive care and clinical practice guidelines for more information on diabetes.
  • Refer to our Quality Care 2026 booklet on HEDIS® measures for information on documentation, coding and exclusions for these measures. You can access it in  Availity® Essentials in the Resources section of our payer space. 
  • See our article on other HEDIS measures related to diabetes care.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

HEDIS is a registered trademark of NCQA.