BlueCross BlueShield on the Rochester Area (BCBSRA) initiated a clinical quality improvement project that increased its diabetic retinopathy screening rate from 42.8% in 1995 to 58.1% in 1997. A multidisciplinary team examined the processes and discovered both member (patient) and provider (physician) barriers to annual screening. Members did not understand the clinical importance and were uncertain as to how frequently diabetic eye examinations were covered by insurance. Providers identified a role for BCBSRA to reinforce patient education on eye examinations and to assist with tracking of services. Involvement of these key stakeholders was critical to understanding and overcoming barriers.