Blue Cross and Blue Shield of New Mexico

October 2016

Improving Coordination of Care for Our Members with Diabetes

In keeping with clinical practice guidelines,1 BCBSNM members diagnosed with diabetes should have an annual dilated, comprehensive eye exam performed by an ophthalmologist or optometrist to determine if the disease has caused damage to the eye. Diabetic changes in the eye, most commonly called retinopathy, which can lead to vision loss and blindness, is treatable. To help ensure members diagnosed with diabetes are receiving quality care, BCBSNM performs annual assessments through claims filed with BCBSNM and review of medical records data, as part of our goal to help improve continuity and coordination of care.

Through a recent analysis, it has come to our attention that some members’ eye exam results from specialists are not being reported back to the referring providers. BCBSNM needs your assistance to help ensure that our members receive this important evaluation, and evaluation results are properly documented in the referring practitioners’ records. This quality improvement initiative depends largely upon communication between eye care specialists and referring providers, such as including a note with the referral asking to send the results back, or the eye care specialist sending a letter with the results of the exam to the referring provider. With your help, we look forward to improving the coordination of care for our members with diabetes.

1Standards of Medical Care in Diabetes – 2016, American Diabetes Associations,

The information mentioned here is for educational purposes only and is not a substitute for the independent medical judgment of a physician. Health care providers are instructed to exercise their own independent medical judgment based upon the patient’s medical condition and history. Regardless of benefits, the final decision about any treatment is between the member and their health care provider.


Blue Review • October 2016

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an Independent Licensee of the Blue Cross and Blue Shield Association.

P.O.Box 27630, Albuquerque, NM 87125-7630