The BCBSRI Quality Team would like to remind all primary care providers participating in the PCP Quality Incentive Program (PQIP) that member panels will freeze starting with October Gaps in Care (GIC) reporting. Please remember to review your attributed patient panel each month throughout the year, as no changes can be made to measure member populations once panels are frozen.

Additionally, starting with August GIC reporting, BCBSRI reporting will change over to utilize the HEDIS MY24 specifications. Important notes for this change:

• The Colorectal Cancer Screening (COL) measure is retired for HEDIS MY2024 and the ECDS version COL-E has replaced it.
• The Hemoglobin A1c Control for Patients with Diabetes measure (HBD) has changed its name and acronym to Glycemic status Assessment for Patients with Diabetes (GSD).
• NCQA made a change to the denominator criteria for the diabetes measures for MY24 to improve the accuracy of the members identified as having diabetes. Members who are identified as having diabetes from claims now require two diagnoses of diabetes no matter what setting. Prior specifications only required one diagnosis if the setting was inpatient which led to the identification of some members who do not have diabetes. Members who are identified as having diabetes from pharmacy data will now also be required to have at least one diagnosis of diabetes in claims. This change is to eliminate the members who are on a diabetes medication for weight loss only. We expect these changes to lead to a decrease in the number of members identified as having diabetes.

Please contact the Quality Concierge Team at QualityHEDIS@bcbsri.org for assistance with Gaps in Care reporting, PQIP program details, or any questions.