Did you know that YOU are practicing in a healthcare system where the traditional fee for service model is giving way to value based care, and how essential YOU are in that shift?
As a diabetes professional, you will want to keep up to date on this upheaval of traditional models of care. You have the opportunity to take a leadership role and demonstrate your worthAs a diabetes professional, you will want to keep up to date on this upheaval of traditional models of care. You have the opportunity to take a leadership role and demonstrate your worth.
Healthcare is changing, and it is changing quickly. Terms like digital quality measures (dQMs), HEDIS®, STAR Ratings, interoperability, value-based contracting, artificial intelligence, and digital health technology are appearing more frequently in healthcare conversations.
Healthcare Is Changing | Value-Based Diabetes Care
While some of these concepts may seem far removed from day-to-day diabetes education, they are increasingly influencing how healthcare is delivered, measured, and reimbursed.
Today’s diabetes technologies such as continuous glucose monitors (CGMs), connected insulin delivery systems, and digital apps generate rich patient data that support chronic disease management and contribute to digital quality reporting. For diabetes care and education specialists (DCESs), understanding these trends is becoming more than simply staying current. It is about recognizing how our profession can continue to grow and demonstrate value within an evolving healthcare system.
Why Is Healthcare Changing?
Healthcare is shifting because the current system is increasingly unsustainable. Costs continue to rise, outcomes remain uneven, and clinicians face growing administrative and reporting burdens that take time away from patient care. As a result, the United States healthcare system is moving from a fee for service model that rewards volume to one that emphasizes quality, outcomes, patient experience, and cost effectiveness. This shift is reflected in the Quintuple Aim, a framework that defines “what better care” means today.
Originally introduced as the Triple Aim by the Institute for Healthcare Improvement, it has expanded to include clinician well-being and health equity. The Quintuple Aim focuses on:
- Improving population health
- Enhancing patient experience
- Improving provider well-being
- Reducing cost of care
- Advancing health equity
Achieving these goals requires better data, stronger care coordination, and more meaningful ways to measure quality across the healthcare continuum.
What Are Digital Quality Measures?
Historically, quality measures relied on manual chart reviews or administrative claims data collected long after care was delivered. Today, healthcare is moving toward digital quality measures, which use electronic health records, patient generated health data, and interoperable systems to evaluate care more efficiently and more accurately. Programs such as HEDIS® and Medicare STAR Ratings continue to play an important role in measuring healthcare performance. As quality measurement becomes increasingly digital, organizations are looking for ways to improve outcomes while creating a better experience for both clinicians and the people they serve.
The Burden of Documentation and How Digital Measures Reduce It
Clinicians today are overwhelmed by documentation requirements, reporting tasks, and manual data entry that often feel disconnected from actual patient care. Much of this work happens outside the visit, reviewing charts, pulling reports, reconciling data, and ensuring that quality metrics are accurately captured.
Manual Process
Manual chart reviews- time consuming and prone to error
Data reconciliation- pulling information from multiple systems
Tracking missed care gaps- directly affecting quality scores
Inconsistent documentation- variability across clinicians
Digital Solution
Automated data capture- improves accuracy and reduces variability
Integration of CGM data- connecting patient generated health data directly to quality metric reporting
Real time gap identification-spots missing care gaps such as retinal eye exams or overdue kidney function testing
Reduced administrative burden- frees up clinician time and could lower cost of care
By shifting quality reporting from manual processes to automated digital workflows, healthcare organizations can create a more streamlined experience for both care teams and patients. More accurate and timely data supports better decision making, improved outcomes, and stronger performance in value based care programs.
Updated HEDIS® Measures and the Role of CGM
Recent updates to HEDIS® reflect the growing role of diabetes technology in routine care, particularly CGM’s. For the 2024 measurement year, NCQA updated the Hemoglobin A1c Control for Patients With Diabetes measure and renamed it Glycemic Status Assessment for Patients With Diabetes, allowing either hemoglobin A1c or glucose management indicator (GMI) derived from CGM data to be used when assessing glycemic status. Looking ahead, NCQA has proposed a new HEDIS measure, Continuous Glucose Monitoring Utilization for Patients With Diabetes, for the 2027 measurement year, which would track CGM use among adults with diabetes. While there is interest in expanding CGM based reporting beyond glucose management indicator to include metrics such as time in range, those elements have not yet been formally incorporated into HEDIS. Together, these changes reflect a growing alignment between diabetes technology and value-based care, reinforcing CGM as a meaningful tool for improving outcomes and meeting evolving quality expectations.
Why This Matters to Diabetes Healthcare Professionals?
As healthcare continues to evolve, you are uniquely positioned to help organizations navigate this transformation. The shift toward digital quality measures, expanded use of CGM data, and growing emphasis on value-based care highlight the need for clinicians who understand both the human side of diabetes and the technology that increasingly supports it. You already excel at patient engagement, technology adoption, behavior change, and chronic disease management, all core drivers of quality performance. By deepening familiarity with digital reporting, leveraging diabetes technology, and helping with closing care gaps, you can play an even more influential role in improving outcomes and demonstrating value across the healthcare system. This transition represents not just a change in how care is measured, but an opportunity for you to help shape what high quality diabetes care looks like in a digital future.
- Get ready! Emerging digital tools and quality programs are transforming diabetes care delivery and reporting.
- HEDIS® updates are increasingly incorporating CGM data, reflecting stronger alignment between diabetes technology and value‑based care.
- Diabetes Healthcare professionals are uniquely positioned to lead the transition to digital, value‑based diabetes care by leveraging their expertise in engagement, technology adoption, and care gap closure.
Join Marie Frazzitta for the FREE webcast
Sept. 30 at 11:30 am PST
Lead the Transformation!
Join this exclusive 30‑minute exclusive session, lead by expert Marie Frazzitta, DNP, FNP‑C, PMHNP, CDCES, MBA, who will provide a high‑level overview of how digital quality measures, CGM data, and value‑based care are transforming diabetes care delivery and reporting. You’ll learn how these shifts create new opportunities for diabetes health professionals to lead, demonstrate value, and shape the future of technology‑enabled diabetes care.
Meet National Expert | Marie Frazzitta, FNP‑BC, DNP, MBA, CDCES, PMHNP
Marie is a nurse practitioner and healthcare strategist with experience across health systems, payer organizations, and digital diabetes technology. She brings a rare cross‑sector perspective to diabetes care, quality improvement, and digital health, helping organizations modernize chronic disease management and prepare for digital quality transformation.
Marie’s work spans clinical leadership, population‑health strategy, value‑based care performance, and digital innovation. Board certified as a Family Nurse Practitioner and trained as a Psychiatric Mental Health Nurse Practitioner, she integrates whole‑person care, behavioral science, and technology‑enabled practice to strengthen patient engagement and improve outcomes.
She has published and presented nationally on diabetes care (Type 1, Type 2, and diabetes in pregnancy), diabetes technology, digital quality measures, and patient engagement strategies including motivational interviewing.
Marie contributes to national initiatives through advisory and leadership roles with organizations such as the Association of Diabetes Care & Education Specialists (ADCES), the American Diabetes Association (ADA), and National Committee for Quality Assurance (NCQA), supporting workgroups and committees focused on diabetes care, digital quality measurement, and innovation.
