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For most health plans, routine vision benefits are treated as just that – routine. An included exam, a pair of glasses, a checked box on a long list of supplemental benefits.
But when it comes to the HEDIS® Eye Exam for Patients with Diabetes (EED) measure, that same benefit goes far beyond eyewear. And the stakes of overlooking it are higher than many realize.
More Than a Routine Exam
The HEDIS® EED is one of the few quality measures that checks multiple boxes: it supports chronic condition management, helps prevent vision loss, and is directly tied to the routine vision benefit. Despite its importance, performance is often left to chance, with health plans relying on members to self-schedule or providers to prioritize it among dozens of other care gaps.
The result is missed opportunities across the board:
ü Missed compliance points that could have elevated Star ratings
ü Missed bonus dollars tied to quality performance
ü Missed diagnoses that could have prevented vision loss
Why Inaction Still Has Consequences
There’s a quiet cost to assuming eye exams for those with diabetes will just get done. We’ve seen plans:
- Lose a full Star rating due to a narrow drop in HEDIS® EED performance
- Struggle to track compliance due to claims lag and limited visibility
- Waste the potential of a benefit that could otherwise drive meaningful quality gains
The HEDIS® EED measure isn’t new. The data on diabetic retinopathy isn’t ambiguous. What’s missing in many programs is simply a model that closes the gap consistently – and at scale.
Multiple Channels; One Goal
What we’ve learned over decades of managing vision care is that it takes a village to close care gaps at every opportunity. It takes both routine vision providers as well as primary care physicians (PCPs) – activated in parallel – to meaningfully move the needle on completing this measure.
ü Members need education, scheduling help, and reminders.
ü PCPs need tools like retinal cameras, a web portal with real-time information, and a simple way to access results.
ü Plans need transparency and timely data to measure impact and adjust quickly.
When these pieces come together, performance follows.
What Plan Leaders Should Be Asking Themselves
As you prepare your routine vision benefits for 2027, here are a few questions worth asking:
- Are we using our routine vision benefit to fully support our diabetes management strategy, or are we overlooking this critical component?
- Are we equipping PCPs to screen for diabetic retinopathy or expecting them to manage it off the side of their desks?
- Is our routine vision benefit doing more than providing eyewear? Is it helping us meet performance goals?
- How can a strategic HEDIS® EED partnership with our vision vendor support diabetes care management programs?
If the answers raise more questions, that’s an opportunity for improvement.
At Health Network One, we manage the full member experience, from scheduling to claims to high-touch customer service, and pair these efforts with a fully embedded HEDIS® EED program that does more than track performance – it improves it.
Our multi-channel model includes:
- Member Outreach: Through mailings and live outreach, members are guided to complete their annual vision exams with in-network routine vision providers.
- PCP Enablement: We partner with plans to embed cameras in high-volume primary care organizations and Federally Qualified Health Centers. This way, PCPs are also activated as partners in quality, with the ability to use our portable retinal cameras to complete retinal screenings.
And our real-time portal enables:
- Faster compliance tracking
- Smarter provider engagement
- Smoother submissions of retinal images and interpretations of screenings
- Actionable data that shows real-time Stars performance
Doing nothing is risky – for both your members and your plan – because, in the world of HEDIS® measures, inaction has a cost. Sometimes it’s a half-Star rating. Sometimes it’s a preventable health issue that worsens quietly until it can’t be reversed.
The good news? A better outcome is within reach, and it starts with seeing routine vision as something more than routine.
Talk to us about your 2027 bid and how we can help you see Stars! Discover what’s possible today at https://www.healthnetworkone.com/hedis-eed-compliance.