Championing Quality Care Through Clinical Practice Guidelines

As a VSP^® Ambassador, you have an important role in advancing consistent, high-quality care across the network. Clinical practice guidelines help align care delivery, improve patient outcomes, and reinforce standardized, evidence-based clinical practices. 

Over the past 12 months, VSP’s quarterly Clinical Practice Guideline (CPG) metrics, reported to our Quality Management Committee and Board of Directors, have not met expectations. These results are also shared externally with clients, Departments of Insurance, and oversight organizations such as the Department of Managed Health Care (DMHC) and the National Committee for Quality Assurance (NCQA). With increased external visibility and scrutiny, consistent performance and clear documentation are essential. 

Diabetes care remains a key focus. To improve care standards and clinical documentation for patients with diabetes, VSP is focused on three priorities: 

• Completion of a dilated retinal exam or clear documentation of clinical rationale when dilation is not performed 
• Communication of exam results to the patient’s primary care provider or physician managing diabetes care, following the examination, even when retinopathy is minimal or not present  
• Overall adherence to clinical practice guidelines 

Note: When clinically appropriate, additional diagnostic procedures, such as retinal imaging, may be used to evaluate diabetic retinopathy. However, retinal imaging alone does not replace the standard of care of a comprehensive dilated retinal exam for patients with diabetes. If dilation is not performed, the clinical rationale must be clearly documented, such as patient refusal, a recent examination, scheduled follow-up, co-management, or medical contraindication. 

Ambassador Action Requested: 
Reinforce the expectation for complete documentation, consistent guideline adherence, and timely provider communication. Address gaps when you see them and model best practices in your own care delivery. Your leadership is critical to closing performance gaps, meeting regulatory expectations, and ensuring we deliver consistent, high-quality care across the network. 

Providers can reference the VSP Provider Reference Manual on eyefinity.com or email providernetworkdevelopment@vsp.com.