Evidence
August 7, 2025Population Health Article / Publication
This article addresses significant disparities in diabetes care within the United States, focusing on the underdiagnosis, undertreatment, and worse health outcomes experienced by minority populations, particularly Black and Hispanic individuals. It highlights the underutilization of Continuous Glucose Monitors (CGMs), a technology proven to improve diabetes management, despite clinical and economic benefits. The authors identify barriers to equitable access to CGMs, including high costs, insurance coverage limitations, and provider-level biases that result in less frequent discussions of this technology with minority patients. Finally, the writers propose policy changes by both private and public insurers and the increased promotion of patient education programs as crucial steps to reduce these disparities and enhance diabetes care for all.
Click here to watch the accompanying videos.
Learn MoreJune 9, 2025CGM Technology and Digital Health CE Activities
Download a comprehensive listing of continuing education (CE) programs for pharmacists, physicians and nurses on the topic of CGM.
Learn More
April 21, 2025Clinical Outcomes Article / Publication
Among semaglutide users with T2D, use of CGM was associated with greater decreases in A1c compared to non-CGM users, regardless of insulin therapy. Reductions in A1c were greater for CGM users (-0.85%) compared to the control group (-0.29%) in the overall cohort (differences-in-differences (DID), -0.55%, P<0.0001). The proportion of CGM and semaglutide users who met the ADA target of A1c <7% nearly doubled compared to baseline. The proportion of CGM and semaglutide users who met the HEDIS target of A1c <8% increased by more than 50% compared to 12% for non-CGM users. These results suggest an additive effect of CGM and semaglutide, and their combined use could help more people with T2D reach their glycemic targets. The possible mechanisms underlying the additive benefit between CGM and semaglutide could include improved diabetes management self-efficacy (related to diet, exercise, and medication adherence) and more effective medication titration. CGM may enhance patient understanding and management of T2D, including those on GLP-1s.
Learn MoreApril 21, 2025Clinical Outcomes Article / Publication
CGM use was associated with -0.62% A1c reduction at 3 months in people with diabetes on basal only or non-insulin therapies in the primary care setting. CGM use significantly improved glycemic control in T2D patients irrespective of treatment regimen (non-insulin or basal insulin). This study was conducted in collaboration with the American Medical Group Association (AMGA).
Learn More
April 15, 2025Clinical Outcomes CGM Best Practices / Interview
Expert: Juan Espinoza , MD, Chief Research Informatics Officer, Ann & Robert H. Lurie Children’s Hospital of Chicago NCQA Panel Committee Member, Diabetes Digital Technologies Roundtable participant (NCQA and ADA), NCQA Health Innovation Summit presenter
Summary: As CGM technology has revolutionized diabetes management, NCQA has recognized a need for more sophisticated measures to assess diabetes care quality. Since integrating the glucose management indicator (GMI) into their HEDIS measure set for 2024, NCQA and other key opinion leaders are looking at integrating further sophisticated metrics from CGM in the future. In this expert interview, Dr. Juan Espinoza shares key insights around the latest considerations on quality improvement in diabetes care relative to CGM-exclusive metrics. Having conducted years of research in the diabetes technology and quality space, Dr. Espinoza discusses evolving quality measures and their potential to advance diabetes management by incorporating a more comprehensive approach. In addition, he provides an overview of the value realized by payers and providers from integration of CGM data directly into the electronic health record.
Experts Recommend Integration of CGM in Payer Diabetes Management Programs and Risk-Sharing Agreements with Providers
April 8, 2025Coverage and Benefit Design Article / Publication
An expert panel of 4 payer and 6 provider stakeholders was convened to discuss opportunities for CGM-based care management in risk-sharing agreements between payers and providers. The panelists were surveyed before 2 virtual roundtable meetings, during which pertinent clinical and trend data were shared.
All payer participants cited using interdisciplinary care management for type 2 diabetes (T2D) and 50% used a digital health platform, but only 25% featured an integrated CGM component. All payer participants responded that “fingerstick” glucose management was either inadequate or questionable for use in current care management programs for T2D. Conversely, 100% also responded that CGM would improve their care delivery solutions. These findings were published as an abstract in the Journal of Managed Care and Specialty Pharmacy and presented in a poster at the 2025 Academy of Managed Care Pharmacy Annual Meeting, including parameters for optimizing risk-sharing agreements incorporating CGM. Specifically, the expert panelists outlined 3 key elements of risk-sharing agreements: agreement design, realistic outcomes measures, and strategies to facilitate payer and provider participation. The recommendations provided by the panel may be valuable for managed care and payer decision makers in shaping risk-sharing agreements to advance the utilization of CGM and improve member outcomes in the management of T2D.
Albright J, McCormick D, Pourarsalan H, Pangrace M. Payer-Provider Risk-Sharing Agreements to Advance Continuous Glucose Monitoring–Based Care in Type 2 Diabetes. Presented at the AMCP Annual Meeting; Houston, TX: April 2, 2025. [Poster E6.]
Learn MoreFebruary 4, 2025Population Health Article / Publication
The Ohio Diabetes Quality Improvement Project (QIP), focused on multisector collaborative approaches, reduced the percentage of patients with A1c >9% from 25% to 20% over two years. In response to barriers voiced by providers and patients, Medicaid payers added coverage for diabetes self-management education and removed prior authorization requirements for continuous glucose monitoring (CGM) within select populations. These efforts enhanced equity to Medicaid enrollees by making it easier to obtain and afford diabetes management supplies and resources.
Learn MoreJanuary 16, 2025Population Health Population Health
In a recent cross-sectional study of electronic health record data, researchers found low rates of CGM prescription orders among Federally Qualified Health Center patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). A total of 1,168 patients with T1D and 35,216 patients with T2D were included. Overall, CGM prescriptions were infrequent, with 11.0% of patients with T1D and 1.0% of patients with T2D receiving a prescription. Disparities in CGM orders were also observed among patients reporting Hispanic ethnicity, Black race, and those who lacked health insurance. Specifically, patients with T1D or T2D who reported Hispanic ethnicity, Black race, or were uninsured had lower multivariable odds of receiving a CGM prescription than White or insured adults (odds ratio [OR], 0.30-0.76). Among patients with T2D, HbA1c values >9.0% (OR, 3.17; 95% CI, 2.37-4.21) and a greater burden of diabetes complications were associated with higher odds of CGM prescription. These findings are of particular interest to managed care and payer stakeholders seeking to identify and address the impact of social determinants of health in vulnerable patient populations.
Wallia A, Agarwal S, Owen AL, et al. Disparities in Continuous Glucose Monitoring Among Patients Receiving Care in Federally Qualified Health Centers. JAMA Netw Open. 2024;7(11):e2445316.
Learn MoreJanuary 16, 2025Clinical Outcomes Guidelines / Policy
The recently issued 2025 ADA Standards of Care offered new guidance supporting CGM use in broader patient populations, the application of CGM metrics in achieving glycemic goals, and the integration of CGM with other diabetes technologies at diagnosis. Specifically, the 2025 Standards of Care recommend considering the use of CGM in adults with T2D NIT to achieve and maintain individualized glycemic goals. Reasserting the clinical value of CGM in type 1 diabetes in pregnancy, the ADA added that CGM may also be beneficial for gestational diabetes and T2D in pregnancy in the 2025 update. ADA also expanded their recommendation for CGM use in individuals with diabetes on any insulin therapy to include youths as well as adults. While previous versions of the Standards of Care stated that CGM metrics should not be used as a substitute for BGM, the 2025 update notes that CGM metrics can be used in conjunction with blood glucose monitoring to achieve glycemic goals. Highlighting the importance of early intervention, the ADA also recommends initiation of CGM, continuous subcutaneous insulin infusion, and automated insulin delivery at diagnosis, depending on a person’s or caregiver’s needs and preferences. These updates are relevant to managed care and payer decision makers in the development of clinically appropriate coverage policies that enhance access to CGM in broader patient populations.
American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S6-S13.
Learn MoreJanuary 14, 2025Clinical Outcomes Article / Publication
As many health plans transition to a value-based diabetes care approach, there is a need for standardized quality measures to assess and benchmark performance. This article addresses key topics to support the adoption of continuous glucose monitoring (CGM) technology in these efforts.
- Transition from Fee-for-Service to Value-Based Care
- Integration of Glucose Management Indicator (GMI) into 2024 NCQA HEDIS Measures
- Impact of CGM on Health Plan Quality Scores & Reimbursement
- Call for Health Systems and Plans to Collaborate with Electronic Health Record Developers
Learn More
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
This article addresses significant disparities in diabetes care within the United States, focusing on the underdiagnosis, undertreatment, and worse health outcomes experienced by minority populations, particularly Black and Hispanic individuals. It highlights the underutilization of Continuous Glucose Monitors (CGMs), a technology proven to improve diabetes management, despite clinical and economic benefits. The authors identify barriers to equitable access to CGMs, including high costs, insurance coverage limitations, and provider-level biases that result in less frequent discussions of this technology with minority patients. Finally, the writers propose policy changes by both private and public insurers and the increased promotion of patient education programs as crucial steps to reduce these disparities and enhance diabetes care for all.
Click here to watch the accompanying videos.
June 9, 2025CGM Technology and Digital Health CE Activities
Download a comprehensive listing of continuing education (CE) programs for pharmacists, physicians and nurses on the topic of CGM.
Learn More
April 21, 2025Clinical Outcomes Article / Publication
Among semaglutide users with T2D, use of CGM was associated with greater decreases in A1c compared to non-CGM users, regardless of insulin therapy. Reductions in A1c were greater for CGM users (-0.85%) compared to the control group (-0.29%) in the overall cohort (differences-in-differences (DID), -0.55%, P<0.0001). The proportion of CGM and semaglutide users who met the ADA target of A1c <7% nearly doubled compared to baseline. The proportion of CGM and semaglutide users who met the HEDIS target of A1c <8% increased by more than 50% compared to 12% for non-CGM users. These results suggest an additive effect of CGM and semaglutide, and their combined use could help more people with T2D reach their glycemic targets. The possible mechanisms underlying the additive benefit between CGM and semaglutide could include improved diabetes management self-efficacy (related to diet, exercise, and medication adherence) and more effective medication titration. CGM may enhance patient understanding and management of T2D, including those on GLP-1s.
Learn MoreApril 21, 2025Clinical Outcomes Article / Publication
CGM use was associated with -0.62% A1c reduction at 3 months in people with diabetes on basal only or non-insulin therapies in the primary care setting. CGM use significantly improved glycemic control in T2D patients irrespective of treatment regimen (non-insulin or basal insulin). This study was conducted in collaboration with the American Medical Group Association (AMGA).
Learn More
April 15, 2025Clinical Outcomes CGM Best Practices / Interview
Expert: Juan Espinoza , MD, Chief Research Informatics Officer, Ann & Robert H. Lurie Children’s Hospital of Chicago NCQA Panel Committee Member, Diabetes Digital Technologies Roundtable participant (NCQA and ADA), NCQA Health Innovation Summit presenter
Summary: As CGM technology has revolutionized diabetes management, NCQA has recognized a need for more sophisticated measures to assess diabetes care quality. Since integrating the glucose management indicator (GMI) into their HEDIS measure set for 2024, NCQA and other key opinion leaders are looking at integrating further sophisticated metrics from CGM in the future. In this expert interview, Dr. Juan Espinoza shares key insights around the latest considerations on quality improvement in diabetes care relative to CGM-exclusive metrics. Having conducted years of research in the diabetes technology and quality space, Dr. Espinoza discusses evolving quality measures and their potential to advance diabetes management by incorporating a more comprehensive approach. In addition, he provides an overview of the value realized by payers and providers from integration of CGM data directly into the electronic health record.
Experts Recommend Integration of CGM in Payer Diabetes Management Programs and Risk-Sharing Agreements with Providers
April 8, 2025Coverage and Benefit Design Article / Publication
An expert panel of 4 payer and 6 provider stakeholders was convened to discuss opportunities for CGM-based care management in risk-sharing agreements between payers and providers. The panelists were surveyed before 2 virtual roundtable meetings, during which pertinent clinical and trend data were shared.
All payer participants cited using interdisciplinary care management for type 2 diabetes (T2D) and 50% used a digital health platform, but only 25% featured an integrated CGM component. All payer participants responded that “fingerstick” glucose management was either inadequate or questionable for use in current care management programs for T2D. Conversely, 100% also responded that CGM would improve their care delivery solutions. These findings were published as an abstract in the Journal of Managed Care and Specialty Pharmacy and presented in a poster at the 2025 Academy of Managed Care Pharmacy Annual Meeting, including parameters for optimizing risk-sharing agreements incorporating CGM. Specifically, the expert panelists outlined 3 key elements of risk-sharing agreements: agreement design, realistic outcomes measures, and strategies to facilitate payer and provider participation. The recommendations provided by the panel may be valuable for managed care and payer decision makers in shaping risk-sharing agreements to advance the utilization of CGM and improve member outcomes in the management of T2D.
Albright J, McCormick D, Pourarsalan H, Pangrace M. Payer-Provider Risk-Sharing Agreements to Advance Continuous Glucose Monitoring–Based Care in Type 2 Diabetes. Presented at the AMCP Annual Meeting; Houston, TX: April 2, 2025. [Poster E6.]
Learn MoreFebruary 4, 2025Population Health Article / Publication
The Ohio Diabetes Quality Improvement Project (QIP), focused on multisector collaborative approaches, reduced the percentage of patients with A1c >9% from 25% to 20% over two years. In response to barriers voiced by providers and patients, Medicaid payers added coverage for diabetes self-management education and removed prior authorization requirements for continuous glucose monitoring (CGM) within select populations. These efforts enhanced equity to Medicaid enrollees by making it easier to obtain and afford diabetes management supplies and resources.
Learn MoreJanuary 16, 2025Population Health Population Health
In a recent cross-sectional study of electronic health record data, researchers found low rates of CGM prescription orders among Federally Qualified Health Center patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). A total of 1,168 patients with T1D and 35,216 patients with T2D were included. Overall, CGM prescriptions were infrequent, with 11.0% of patients with T1D and 1.0% of patients with T2D receiving a prescription. Disparities in CGM orders were also observed among patients reporting Hispanic ethnicity, Black race, and those who lacked health insurance. Specifically, patients with T1D or T2D who reported Hispanic ethnicity, Black race, or were uninsured had lower multivariable odds of receiving a CGM prescription than White or insured adults (odds ratio [OR], 0.30-0.76). Among patients with T2D, HbA1c values >9.0% (OR, 3.17; 95% CI, 2.37-4.21) and a greater burden of diabetes complications were associated with higher odds of CGM prescription. These findings are of particular interest to managed care and payer stakeholders seeking to identify and address the impact of social determinants of health in vulnerable patient populations.
Wallia A, Agarwal S, Owen AL, et al. Disparities in Continuous Glucose Monitoring Among Patients Receiving Care in Federally Qualified Health Centers. JAMA Netw Open. 2024;7(11):e2445316.
Learn MoreJanuary 16, 2025Clinical Outcomes Guidelines / Policy
The recently issued 2025 ADA Standards of Care offered new guidance supporting CGM use in broader patient populations, the application of CGM metrics in achieving glycemic goals, and the integration of CGM with other diabetes technologies at diagnosis. Specifically, the 2025 Standards of Care recommend considering the use of CGM in adults with T2D NIT to achieve and maintain individualized glycemic goals. Reasserting the clinical value of CGM in type 1 diabetes in pregnancy, the ADA added that CGM may also be beneficial for gestational diabetes and T2D in pregnancy in the 2025 update. ADA also expanded their recommendation for CGM use in individuals with diabetes on any insulin therapy to include youths as well as adults. While previous versions of the Standards of Care stated that CGM metrics should not be used as a substitute for BGM, the 2025 update notes that CGM metrics can be used in conjunction with blood glucose monitoring to achieve glycemic goals. Highlighting the importance of early intervention, the ADA also recommends initiation of CGM, continuous subcutaneous insulin infusion, and automated insulin delivery at diagnosis, depending on a person’s or caregiver’s needs and preferences. These updates are relevant to managed care and payer decision makers in the development of clinically appropriate coverage policies that enhance access to CGM in broader patient populations.
American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S6-S13.
Learn MoreJanuary 14, 2025Clinical Outcomes Article / Publication
As many health plans transition to a value-based diabetes care approach, there is a need for standardized quality measures to assess and benchmark performance. This article addresses key topics to support the adoption of continuous glucose monitoring (CGM) technology in these efforts.
- Transition from Fee-for-Service to Value-Based Care
- Integration of Glucose Management Indicator (GMI) into 2024 NCQA HEDIS Measures
- Impact of CGM on Health Plan Quality Scores & Reimbursement
- Call for Health Systems and Plans to Collaborate with Electronic Health Record Developers
Learn More
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
Download a comprehensive listing of continuing education (CE) programs for pharmacists, physicians and nurses on the topic of CGM.
Learn MoreApril 21, 2025Clinical Outcomes Article / Publication
Among semaglutide users with T2D, use of CGM was associated with greater decreases in A1c compared to non-CGM users, regardless of insulin therapy. Reductions in A1c were greater for CGM users (-0.85%) compared to the control group (-0.29%) in the overall cohort (differences-in-differences (DID), -0.55%, P<0.0001). The proportion of CGM and semaglutide users who met the ADA target of A1c <7% nearly doubled compared to baseline. The proportion of CGM and semaglutide users who met the HEDIS target of A1c <8% increased by more than 50% compared to 12% for non-CGM users. These results suggest an additive effect of CGM and semaglutide, and their combined use could help more people with T2D reach their glycemic targets. The possible mechanisms underlying the additive benefit between CGM and semaglutide could include improved diabetes management self-efficacy (related to diet, exercise, and medication adherence) and more effective medication titration. CGM may enhance patient understanding and management of T2D, including those on GLP-1s.
Learn MoreApril 21, 2025Clinical Outcomes Article / Publication
CGM use was associated with -0.62% A1c reduction at 3 months in people with diabetes on basal only or non-insulin therapies in the primary care setting. CGM use significantly improved glycemic control in T2D patients irrespective of treatment regimen (non-insulin or basal insulin). This study was conducted in collaboration with the American Medical Group Association (AMGA).
Learn More
April 15, 2025Clinical Outcomes CGM Best Practices / Interview
Expert: Juan Espinoza , MD, Chief Research Informatics Officer, Ann & Robert H. Lurie Children’s Hospital of Chicago NCQA Panel Committee Member, Diabetes Digital Technologies Roundtable participant (NCQA and ADA), NCQA Health Innovation Summit presenter
Summary: As CGM technology has revolutionized diabetes management, NCQA has recognized a need for more sophisticated measures to assess diabetes care quality. Since integrating the glucose management indicator (GMI) into their HEDIS measure set for 2024, NCQA and other key opinion leaders are looking at integrating further sophisticated metrics from CGM in the future. In this expert interview, Dr. Juan Espinoza shares key insights around the latest considerations on quality improvement in diabetes care relative to CGM-exclusive metrics. Having conducted years of research in the diabetes technology and quality space, Dr. Espinoza discusses evolving quality measures and their potential to advance diabetes management by incorporating a more comprehensive approach. In addition, he provides an overview of the value realized by payers and providers from integration of CGM data directly into the electronic health record.
Experts Recommend Integration of CGM in Payer Diabetes Management Programs and Risk-Sharing Agreements with Providers
April 8, 2025Coverage and Benefit Design Article / Publication
An expert panel of 4 payer and 6 provider stakeholders was convened to discuss opportunities for CGM-based care management in risk-sharing agreements between payers and providers. The panelists were surveyed before 2 virtual roundtable meetings, during which pertinent clinical and trend data were shared.
All payer participants cited using interdisciplinary care management for type 2 diabetes (T2D) and 50% used a digital health platform, but only 25% featured an integrated CGM component. All payer participants responded that “fingerstick” glucose management was either inadequate or questionable for use in current care management programs for T2D. Conversely, 100% also responded that CGM would improve their care delivery solutions. These findings were published as an abstract in the Journal of Managed Care and Specialty Pharmacy and presented in a poster at the 2025 Academy of Managed Care Pharmacy Annual Meeting, including parameters for optimizing risk-sharing agreements incorporating CGM. Specifically, the expert panelists outlined 3 key elements of risk-sharing agreements: agreement design, realistic outcomes measures, and strategies to facilitate payer and provider participation. The recommendations provided by the panel may be valuable for managed care and payer decision makers in shaping risk-sharing agreements to advance the utilization of CGM and improve member outcomes in the management of T2D.
Albright J, McCormick D, Pourarsalan H, Pangrace M. Payer-Provider Risk-Sharing Agreements to Advance Continuous Glucose Monitoring–Based Care in Type 2 Diabetes. Presented at the AMCP Annual Meeting; Houston, TX: April 2, 2025. [Poster E6.]
Learn MoreFebruary 4, 2025Population Health Article / Publication
The Ohio Diabetes Quality Improvement Project (QIP), focused on multisector collaborative approaches, reduced the percentage of patients with A1c >9% from 25% to 20% over two years. In response to barriers voiced by providers and patients, Medicaid payers added coverage for diabetes self-management education and removed prior authorization requirements for continuous glucose monitoring (CGM) within select populations. These efforts enhanced equity to Medicaid enrollees by making it easier to obtain and afford diabetes management supplies and resources.
Learn MoreJanuary 16, 2025Population Health Population Health
In a recent cross-sectional study of electronic health record data, researchers found low rates of CGM prescription orders among Federally Qualified Health Center patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). A total of 1,168 patients with T1D and 35,216 patients with T2D were included. Overall, CGM prescriptions were infrequent, with 11.0% of patients with T1D and 1.0% of patients with T2D receiving a prescription. Disparities in CGM orders were also observed among patients reporting Hispanic ethnicity, Black race, and those who lacked health insurance. Specifically, patients with T1D or T2D who reported Hispanic ethnicity, Black race, or were uninsured had lower multivariable odds of receiving a CGM prescription than White or insured adults (odds ratio [OR], 0.30-0.76). Among patients with T2D, HbA1c values >9.0% (OR, 3.17; 95% CI, 2.37-4.21) and a greater burden of diabetes complications were associated with higher odds of CGM prescription. These findings are of particular interest to managed care and payer stakeholders seeking to identify and address the impact of social determinants of health in vulnerable patient populations.
Wallia A, Agarwal S, Owen AL, et al. Disparities in Continuous Glucose Monitoring Among Patients Receiving Care in Federally Qualified Health Centers. JAMA Netw Open. 2024;7(11):e2445316.
Learn MoreJanuary 16, 2025Clinical Outcomes Guidelines / Policy
The recently issued 2025 ADA Standards of Care offered new guidance supporting CGM use in broader patient populations, the application of CGM metrics in achieving glycemic goals, and the integration of CGM with other diabetes technologies at diagnosis. Specifically, the 2025 Standards of Care recommend considering the use of CGM in adults with T2D NIT to achieve and maintain individualized glycemic goals. Reasserting the clinical value of CGM in type 1 diabetes in pregnancy, the ADA added that CGM may also be beneficial for gestational diabetes and T2D in pregnancy in the 2025 update. ADA also expanded their recommendation for CGM use in individuals with diabetes on any insulin therapy to include youths as well as adults. While previous versions of the Standards of Care stated that CGM metrics should not be used as a substitute for BGM, the 2025 update notes that CGM metrics can be used in conjunction with blood glucose monitoring to achieve glycemic goals. Highlighting the importance of early intervention, the ADA also recommends initiation of CGM, continuous subcutaneous insulin infusion, and automated insulin delivery at diagnosis, depending on a person’s or caregiver’s needs and preferences. These updates are relevant to managed care and payer decision makers in the development of clinically appropriate coverage policies that enhance access to CGM in broader patient populations.
American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S6-S13.
Learn MoreJanuary 14, 2025Clinical Outcomes Article / Publication
As many health plans transition to a value-based diabetes care approach, there is a need for standardized quality measures to assess and benchmark performance. This article addresses key topics to support the adoption of continuous glucose monitoring (CGM) technology in these efforts.
- Transition from Fee-for-Service to Value-Based Care
- Integration of Glucose Management Indicator (GMI) into 2024 NCQA HEDIS Measures
- Impact of CGM on Health Plan Quality Scores & Reimbursement
- Call for Health Systems and Plans to Collaborate with Electronic Health Record Developers
Learn More
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
Among semaglutide users with T2D, use of CGM was associated with greater decreases in A1c compared to non-CGM users, regardless of insulin therapy. Reductions in A1c were greater for CGM users (-0.85%) compared to the control group (-0.29%) in the overall cohort (differences-in-differences (DID), -0.55%, P<0.0001). The proportion of CGM and semaglutide users who met the ADA target of A1c <7% nearly doubled compared to baseline. The proportion of CGM and semaglutide users who met the HEDIS target of A1c <8% increased by more than 50% compared to 12% for non-CGM users. These results suggest an additive effect of CGM and semaglutide, and their combined use could help more people with T2D reach their glycemic targets. The possible mechanisms underlying the additive benefit between CGM and semaglutide could include improved diabetes management self-efficacy (related to diet, exercise, and medication adherence) and more effective medication titration. CGM may enhance patient understanding and management of T2D, including those on GLP-1s.
Learn MoreApril 21, 2025Clinical Outcomes Article / Publication
CGM use was associated with -0.62% A1c reduction at 3 months in people with diabetes on basal only or non-insulin therapies in the primary care setting. CGM use significantly improved glycemic control in T2D patients irrespective of treatment regimen (non-insulin or basal insulin). This study was conducted in collaboration with the American Medical Group Association (AMGA).
Learn More
April 15, 2025Clinical Outcomes CGM Best Practices / Interview
Expert: Juan Espinoza , MD, Chief Research Informatics Officer, Ann & Robert H. Lurie Children’s Hospital of Chicago NCQA Panel Committee Member, Diabetes Digital Technologies Roundtable participant (NCQA and ADA), NCQA Health Innovation Summit presenter
Summary: As CGM technology has revolutionized diabetes management, NCQA has recognized a need for more sophisticated measures to assess diabetes care quality. Since integrating the glucose management indicator (GMI) into their HEDIS measure set for 2024, NCQA and other key opinion leaders are looking at integrating further sophisticated metrics from CGM in the future. In this expert interview, Dr. Juan Espinoza shares key insights around the latest considerations on quality improvement in diabetes care relative to CGM-exclusive metrics. Having conducted years of research in the diabetes technology and quality space, Dr. Espinoza discusses evolving quality measures and their potential to advance diabetes management by incorporating a more comprehensive approach. In addition, he provides an overview of the value realized by payers and providers from integration of CGM data directly into the electronic health record.
Experts Recommend Integration of CGM in Payer Diabetes Management Programs and Risk-Sharing Agreements with Providers
April 8, 2025Coverage and Benefit Design Article / Publication
An expert panel of 4 payer and 6 provider stakeholders was convened to discuss opportunities for CGM-based care management in risk-sharing agreements between payers and providers. The panelists were surveyed before 2 virtual roundtable meetings, during which pertinent clinical and trend data were shared.
All payer participants cited using interdisciplinary care management for type 2 diabetes (T2D) and 50% used a digital health platform, but only 25% featured an integrated CGM component. All payer participants responded that “fingerstick” glucose management was either inadequate or questionable for use in current care management programs for T2D. Conversely, 100% also responded that CGM would improve their care delivery solutions. These findings were published as an abstract in the Journal of Managed Care and Specialty Pharmacy and presented in a poster at the 2025 Academy of Managed Care Pharmacy Annual Meeting, including parameters for optimizing risk-sharing agreements incorporating CGM. Specifically, the expert panelists outlined 3 key elements of risk-sharing agreements: agreement design, realistic outcomes measures, and strategies to facilitate payer and provider participation. The recommendations provided by the panel may be valuable for managed care and payer decision makers in shaping risk-sharing agreements to advance the utilization of CGM and improve member outcomes in the management of T2D.
Albright J, McCormick D, Pourarsalan H, Pangrace M. Payer-Provider Risk-Sharing Agreements to Advance Continuous Glucose Monitoring–Based Care in Type 2 Diabetes. Presented at the AMCP Annual Meeting; Houston, TX: April 2, 2025. [Poster E6.]
Learn MoreFebruary 4, 2025Population Health Article / Publication
The Ohio Diabetes Quality Improvement Project (QIP), focused on multisector collaborative approaches, reduced the percentage of patients with A1c >9% from 25% to 20% over two years. In response to barriers voiced by providers and patients, Medicaid payers added coverage for diabetes self-management education and removed prior authorization requirements for continuous glucose monitoring (CGM) within select populations. These efforts enhanced equity to Medicaid enrollees by making it easier to obtain and afford diabetes management supplies and resources.
Learn MoreJanuary 16, 2025Population Health Population Health
In a recent cross-sectional study of electronic health record data, researchers found low rates of CGM prescription orders among Federally Qualified Health Center patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). A total of 1,168 patients with T1D and 35,216 patients with T2D were included. Overall, CGM prescriptions were infrequent, with 11.0% of patients with T1D and 1.0% of patients with T2D receiving a prescription. Disparities in CGM orders were also observed among patients reporting Hispanic ethnicity, Black race, and those who lacked health insurance. Specifically, patients with T1D or T2D who reported Hispanic ethnicity, Black race, or were uninsured had lower multivariable odds of receiving a CGM prescription than White or insured adults (odds ratio [OR], 0.30-0.76). Among patients with T2D, HbA1c values >9.0% (OR, 3.17; 95% CI, 2.37-4.21) and a greater burden of diabetes complications were associated with higher odds of CGM prescription. These findings are of particular interest to managed care and payer stakeholders seeking to identify and address the impact of social determinants of health in vulnerable patient populations.
Wallia A, Agarwal S, Owen AL, et al. Disparities in Continuous Glucose Monitoring Among Patients Receiving Care in Federally Qualified Health Centers. JAMA Netw Open. 2024;7(11):e2445316.
Learn MoreJanuary 16, 2025Clinical Outcomes Guidelines / Policy
The recently issued 2025 ADA Standards of Care offered new guidance supporting CGM use in broader patient populations, the application of CGM metrics in achieving glycemic goals, and the integration of CGM with other diabetes technologies at diagnosis. Specifically, the 2025 Standards of Care recommend considering the use of CGM in adults with T2D NIT to achieve and maintain individualized glycemic goals. Reasserting the clinical value of CGM in type 1 diabetes in pregnancy, the ADA added that CGM may also be beneficial for gestational diabetes and T2D in pregnancy in the 2025 update. ADA also expanded their recommendation for CGM use in individuals with diabetes on any insulin therapy to include youths as well as adults. While previous versions of the Standards of Care stated that CGM metrics should not be used as a substitute for BGM, the 2025 update notes that CGM metrics can be used in conjunction with blood glucose monitoring to achieve glycemic goals. Highlighting the importance of early intervention, the ADA also recommends initiation of CGM, continuous subcutaneous insulin infusion, and automated insulin delivery at diagnosis, depending on a person’s or caregiver’s needs and preferences. These updates are relevant to managed care and payer decision makers in the development of clinically appropriate coverage policies that enhance access to CGM in broader patient populations.
American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S6-S13.
Learn MoreJanuary 14, 2025Clinical Outcomes Article / Publication
As many health plans transition to a value-based diabetes care approach, there is a need for standardized quality measures to assess and benchmark performance. This article addresses key topics to support the adoption of continuous glucose monitoring (CGM) technology in these efforts.
- Transition from Fee-for-Service to Value-Based Care
- Integration of Glucose Management Indicator (GMI) into 2024 NCQA HEDIS Measures
- Impact of CGM on Health Plan Quality Scores & Reimbursement
- Call for Health Systems and Plans to Collaborate with Electronic Health Record Developers
Learn More
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Updates, Recent News, And Resources
CGM use was associated with -0.62% A1c reduction at 3 months in people with diabetes on basal only or non-insulin therapies in the primary care setting. CGM use significantly improved glycemic control in T2D patients irrespective of treatment regimen (non-insulin or basal insulin). This study was conducted in collaboration with the American Medical Group Association (AMGA).
Learn MoreApril 15, 2025Clinical Outcomes CGM Best Practices / Interview
Expert: Juan Espinoza , MD, Chief Research Informatics Officer, Ann & Robert H. Lurie Children’s Hospital of Chicago NCQA Panel Committee Member, Diabetes Digital Technologies Roundtable participant (NCQA and ADA), NCQA Health Innovation Summit presenter
Summary: As CGM technology has revolutionized diabetes management, NCQA has recognized a need for more sophisticated measures to assess diabetes care quality. Since integrating the glucose management indicator (GMI) into their HEDIS measure set for 2024, NCQA and other key opinion leaders are looking at integrating further sophisticated metrics from CGM in the future. In this expert interview, Dr. Juan Espinoza shares key insights around the latest considerations on quality improvement in diabetes care relative to CGM-exclusive metrics. Having conducted years of research in the diabetes technology and quality space, Dr. Espinoza discusses evolving quality measures and their potential to advance diabetes management by incorporating a more comprehensive approach. In addition, he provides an overview of the value realized by payers and providers from integration of CGM data directly into the electronic health record.
Experts Recommend Integration of CGM in Payer Diabetes Management Programs and Risk-Sharing Agreements with Providers
April 8, 2025Coverage and Benefit Design Article / Publication
An expert panel of 4 payer and 6 provider stakeholders was convened to discuss opportunities for CGM-based care management in risk-sharing agreements between payers and providers. The panelists were surveyed before 2 virtual roundtable meetings, during which pertinent clinical and trend data were shared.
All payer participants cited using interdisciplinary care management for type 2 diabetes (T2D) and 50% used a digital health platform, but only 25% featured an integrated CGM component. All payer participants responded that “fingerstick” glucose management was either inadequate or questionable for use in current care management programs for T2D. Conversely, 100% also responded that CGM would improve their care delivery solutions. These findings were published as an abstract in the Journal of Managed Care and Specialty Pharmacy and presented in a poster at the 2025 Academy of Managed Care Pharmacy Annual Meeting, including parameters for optimizing risk-sharing agreements incorporating CGM. Specifically, the expert panelists outlined 3 key elements of risk-sharing agreements: agreement design, realistic outcomes measures, and strategies to facilitate payer and provider participation. The recommendations provided by the panel may be valuable for managed care and payer decision makers in shaping risk-sharing agreements to advance the utilization of CGM and improve member outcomes in the management of T2D.
Albright J, McCormick D, Pourarsalan H, Pangrace M. Payer-Provider Risk-Sharing Agreements to Advance Continuous Glucose Monitoring–Based Care in Type 2 Diabetes. Presented at the AMCP Annual Meeting; Houston, TX: April 2, 2025. [Poster E6.]
Learn MoreFebruary 4, 2025Population Health Article / Publication
The Ohio Diabetes Quality Improvement Project (QIP), focused on multisector collaborative approaches, reduced the percentage of patients with A1c >9% from 25% to 20% over two years. In response to barriers voiced by providers and patients, Medicaid payers added coverage for diabetes self-management education and removed prior authorization requirements for continuous glucose monitoring (CGM) within select populations. These efforts enhanced equity to Medicaid enrollees by making it easier to obtain and afford diabetes management supplies and resources.
Learn MoreJanuary 16, 2025Population Health Population Health
In a recent cross-sectional study of electronic health record data, researchers found low rates of CGM prescription orders among Federally Qualified Health Center patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). A total of 1,168 patients with T1D and 35,216 patients with T2D were included. Overall, CGM prescriptions were infrequent, with 11.0% of patients with T1D and 1.0% of patients with T2D receiving a prescription. Disparities in CGM orders were also observed among patients reporting Hispanic ethnicity, Black race, and those who lacked health insurance. Specifically, patients with T1D or T2D who reported Hispanic ethnicity, Black race, or were uninsured had lower multivariable odds of receiving a CGM prescription than White or insured adults (odds ratio [OR], 0.30-0.76). Among patients with T2D, HbA1c values >9.0% (OR, 3.17; 95% CI, 2.37-4.21) and a greater burden of diabetes complications were associated with higher odds of CGM prescription. These findings are of particular interest to managed care and payer stakeholders seeking to identify and address the impact of social determinants of health in vulnerable patient populations.
Wallia A, Agarwal S, Owen AL, et al. Disparities in Continuous Glucose Monitoring Among Patients Receiving Care in Federally Qualified Health Centers. JAMA Netw Open. 2024;7(11):e2445316.
Learn MoreJanuary 16, 2025Clinical Outcomes Guidelines / Policy
The recently issued 2025 ADA Standards of Care offered new guidance supporting CGM use in broader patient populations, the application of CGM metrics in achieving glycemic goals, and the integration of CGM with other diabetes technologies at diagnosis. Specifically, the 2025 Standards of Care recommend considering the use of CGM in adults with T2D NIT to achieve and maintain individualized glycemic goals. Reasserting the clinical value of CGM in type 1 diabetes in pregnancy, the ADA added that CGM may also be beneficial for gestational diabetes and T2D in pregnancy in the 2025 update. ADA also expanded their recommendation for CGM use in individuals with diabetes on any insulin therapy to include youths as well as adults. While previous versions of the Standards of Care stated that CGM metrics should not be used as a substitute for BGM, the 2025 update notes that CGM metrics can be used in conjunction with blood glucose monitoring to achieve glycemic goals. Highlighting the importance of early intervention, the ADA also recommends initiation of CGM, continuous subcutaneous insulin infusion, and automated insulin delivery at diagnosis, depending on a person’s or caregiver’s needs and preferences. These updates are relevant to managed care and payer decision makers in the development of clinically appropriate coverage policies that enhance access to CGM in broader patient populations.
American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S6-S13.
Learn MoreJanuary 14, 2025Clinical Outcomes Article / Publication
As many health plans transition to a value-based diabetes care approach, there is a need for standardized quality measures to assess and benchmark performance. This article addresses key topics to support the adoption of continuous glucose monitoring (CGM) technology in these efforts.
- Transition from Fee-for-Service to Value-Based Care
- Integration of Glucose Management Indicator (GMI) into 2024 NCQA HEDIS Measures
- Impact of CGM on Health Plan Quality Scores & Reimbursement
- Call for Health Systems and Plans to Collaborate with Electronic Health Record Developers
Learn More
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
Expert: Juan Espinoza , MD, Chief Research Informatics Officer, Ann & Robert H. Lurie Children’s Hospital of Chicago NCQA Panel Committee Member, Diabetes Digital Technologies Roundtable participant (NCQA and ADA), NCQA Health Innovation Summit presenter
Summary: As CGM technology has revolutionized diabetes management, NCQA has recognized a need for more sophisticated measures to assess diabetes care quality. Since integrating the glucose management indicator (GMI) into their HEDIS measure set for 2024, NCQA and other key opinion leaders are looking at integrating further sophisticated metrics from CGM in the future. In this expert interview, Dr. Juan Espinoza shares key insights around the latest considerations on quality improvement in diabetes care relative to CGM-exclusive metrics. Having conducted years of research in the diabetes technology and quality space, Dr. Espinoza discusses evolving quality measures and their potential to advance diabetes management by incorporating a more comprehensive approach. In addition, he provides an overview of the value realized by payers and providers from integration of CGM data directly into the electronic health record.
Experts Recommend Integration of CGM in Payer Diabetes Management Programs and Risk-Sharing Agreements with Providers
April 8, 2025Coverage and Benefit Design Article / Publication
An expert panel of 4 payer and 6 provider stakeholders was convened to discuss opportunities for CGM-based care management in risk-sharing agreements between payers and providers. The panelists were surveyed before 2 virtual roundtable meetings, during which pertinent clinical and trend data were shared.
All payer participants cited using interdisciplinary care management for type 2 diabetes (T2D) and 50% used a digital health platform, but only 25% featured an integrated CGM component. All payer participants responded that “fingerstick” glucose management was either inadequate or questionable for use in current care management programs for T2D. Conversely, 100% also responded that CGM would improve their care delivery solutions. These findings were published as an abstract in the Journal of Managed Care and Specialty Pharmacy and presented in a poster at the 2025 Academy of Managed Care Pharmacy Annual Meeting, including parameters for optimizing risk-sharing agreements incorporating CGM. Specifically, the expert panelists outlined 3 key elements of risk-sharing agreements: agreement design, realistic outcomes measures, and strategies to facilitate payer and provider participation. The recommendations provided by the panel may be valuable for managed care and payer decision makers in shaping risk-sharing agreements to advance the utilization of CGM and improve member outcomes in the management of T2D.
Albright J, McCormick D, Pourarsalan H, Pangrace M. Payer-Provider Risk-Sharing Agreements to Advance Continuous Glucose Monitoring–Based Care in Type 2 Diabetes. Presented at the AMCP Annual Meeting; Houston, TX: April 2, 2025. [Poster E6.]
Learn MoreFebruary 4, 2025Population Health Article / Publication
The Ohio Diabetes Quality Improvement Project (QIP), focused on multisector collaborative approaches, reduced the percentage of patients with A1c >9% from 25% to 20% over two years. In response to barriers voiced by providers and patients, Medicaid payers added coverage for diabetes self-management education and removed prior authorization requirements for continuous glucose monitoring (CGM) within select populations. These efforts enhanced equity to Medicaid enrollees by making it easier to obtain and afford diabetes management supplies and resources.
Learn MoreJanuary 16, 2025Population Health Population Health
In a recent cross-sectional study of electronic health record data, researchers found low rates of CGM prescription orders among Federally Qualified Health Center patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). A total of 1,168 patients with T1D and 35,216 patients with T2D were included. Overall, CGM prescriptions were infrequent, with 11.0% of patients with T1D and 1.0% of patients with T2D receiving a prescription. Disparities in CGM orders were also observed among patients reporting Hispanic ethnicity, Black race, and those who lacked health insurance. Specifically, patients with T1D or T2D who reported Hispanic ethnicity, Black race, or were uninsured had lower multivariable odds of receiving a CGM prescription than White or insured adults (odds ratio [OR], 0.30-0.76). Among patients with T2D, HbA1c values >9.0% (OR, 3.17; 95% CI, 2.37-4.21) and a greater burden of diabetes complications were associated with higher odds of CGM prescription. These findings are of particular interest to managed care and payer stakeholders seeking to identify and address the impact of social determinants of health in vulnerable patient populations.
Wallia A, Agarwal S, Owen AL, et al. Disparities in Continuous Glucose Monitoring Among Patients Receiving Care in Federally Qualified Health Centers. JAMA Netw Open. 2024;7(11):e2445316.
Learn MoreJanuary 16, 2025Clinical Outcomes Guidelines / Policy
The recently issued 2025 ADA Standards of Care offered new guidance supporting CGM use in broader patient populations, the application of CGM metrics in achieving glycemic goals, and the integration of CGM with other diabetes technologies at diagnosis. Specifically, the 2025 Standards of Care recommend considering the use of CGM in adults with T2D NIT to achieve and maintain individualized glycemic goals. Reasserting the clinical value of CGM in type 1 diabetes in pregnancy, the ADA added that CGM may also be beneficial for gestational diabetes and T2D in pregnancy in the 2025 update. ADA also expanded their recommendation for CGM use in individuals with diabetes on any insulin therapy to include youths as well as adults. While previous versions of the Standards of Care stated that CGM metrics should not be used as a substitute for BGM, the 2025 update notes that CGM metrics can be used in conjunction with blood glucose monitoring to achieve glycemic goals. Highlighting the importance of early intervention, the ADA also recommends initiation of CGM, continuous subcutaneous insulin infusion, and automated insulin delivery at diagnosis, depending on a person’s or caregiver’s needs and preferences. These updates are relevant to managed care and payer decision makers in the development of clinically appropriate coverage policies that enhance access to CGM in broader patient populations.
American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S6-S13.
Learn MoreJanuary 14, 2025Clinical Outcomes Article / Publication
As many health plans transition to a value-based diabetes care approach, there is a need for standardized quality measures to assess and benchmark performance. This article addresses key topics to support the adoption of continuous glucose monitoring (CGM) technology in these efforts.
- Transition from Fee-for-Service to Value-Based Care
- Integration of Glucose Management Indicator (GMI) into 2024 NCQA HEDIS Measures
- Impact of CGM on Health Plan Quality Scores & Reimbursement
- Call for Health Systems and Plans to Collaborate with Electronic Health Record Developers
Learn More
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
Experts Recommend Integration of CGM in Payer Diabetes Management Programs and Risk-Sharing Agreements with Providers
An expert panel of 4 payer and 6 provider stakeholders was convened to discuss opportunities for CGM-based care management in risk-sharing agreements between payers and providers. The panelists were surveyed before 2 virtual roundtable meetings, during which pertinent clinical and trend data were shared.
All payer participants cited using interdisciplinary care management for type 2 diabetes (T2D) and 50% used a digital health platform, but only 25% featured an integrated CGM component. All payer participants responded that “fingerstick” glucose management was either inadequate or questionable for use in current care management programs for T2D. Conversely, 100% also responded that CGM would improve their care delivery solutions. These findings were published as an abstract in the Journal of Managed Care and Specialty Pharmacy and presented in a poster at the 2025 Academy of Managed Care Pharmacy Annual Meeting, including parameters for optimizing risk-sharing agreements incorporating CGM. Specifically, the expert panelists outlined 3 key elements of risk-sharing agreements: agreement design, realistic outcomes measures, and strategies to facilitate payer and provider participation. The recommendations provided by the panel may be valuable for managed care and payer decision makers in shaping risk-sharing agreements to advance the utilization of CGM and improve member outcomes in the management of T2D.
Albright J, McCormick D, Pourarsalan H, Pangrace M. Payer-Provider Risk-Sharing Agreements to Advance Continuous Glucose Monitoring–Based Care in Type 2 Diabetes. Presented at the AMCP Annual Meeting; Houston, TX: April 2, 2025. [Poster E6.]
Learn MoreFebruary 4, 2025Population Health Article / Publication
The Ohio Diabetes Quality Improvement Project (QIP), focused on multisector collaborative approaches, reduced the percentage of patients with A1c >9% from 25% to 20% over two years. In response to barriers voiced by providers and patients, Medicaid payers added coverage for diabetes self-management education and removed prior authorization requirements for continuous glucose monitoring (CGM) within select populations. These efforts enhanced equity to Medicaid enrollees by making it easier to obtain and afford diabetes management supplies and resources.
Learn MoreJanuary 16, 2025Population Health Population Health
In a recent cross-sectional study of electronic health record data, researchers found low rates of CGM prescription orders among Federally Qualified Health Center patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). A total of 1,168 patients with T1D and 35,216 patients with T2D were included. Overall, CGM prescriptions were infrequent, with 11.0% of patients with T1D and 1.0% of patients with T2D receiving a prescription. Disparities in CGM orders were also observed among patients reporting Hispanic ethnicity, Black race, and those who lacked health insurance. Specifically, patients with T1D or T2D who reported Hispanic ethnicity, Black race, or were uninsured had lower multivariable odds of receiving a CGM prescription than White or insured adults (odds ratio [OR], 0.30-0.76). Among patients with T2D, HbA1c values >9.0% (OR, 3.17; 95% CI, 2.37-4.21) and a greater burden of diabetes complications were associated with higher odds of CGM prescription. These findings are of particular interest to managed care and payer stakeholders seeking to identify and address the impact of social determinants of health in vulnerable patient populations.
Wallia A, Agarwal S, Owen AL, et al. Disparities in Continuous Glucose Monitoring Among Patients Receiving Care in Federally Qualified Health Centers. JAMA Netw Open. 2024;7(11):e2445316.
Learn MoreJanuary 16, 2025Clinical Outcomes Guidelines / Policy
The recently issued 2025 ADA Standards of Care offered new guidance supporting CGM use in broader patient populations, the application of CGM metrics in achieving glycemic goals, and the integration of CGM with other diabetes technologies at diagnosis. Specifically, the 2025 Standards of Care recommend considering the use of CGM in adults with T2D NIT to achieve and maintain individualized glycemic goals. Reasserting the clinical value of CGM in type 1 diabetes in pregnancy, the ADA added that CGM may also be beneficial for gestational diabetes and T2D in pregnancy in the 2025 update. ADA also expanded their recommendation for CGM use in individuals with diabetes on any insulin therapy to include youths as well as adults. While previous versions of the Standards of Care stated that CGM metrics should not be used as a substitute for BGM, the 2025 update notes that CGM metrics can be used in conjunction with blood glucose monitoring to achieve glycemic goals. Highlighting the importance of early intervention, the ADA also recommends initiation of CGM, continuous subcutaneous insulin infusion, and automated insulin delivery at diagnosis, depending on a person’s or caregiver’s needs and preferences. These updates are relevant to managed care and payer decision makers in the development of clinically appropriate coverage policies that enhance access to CGM in broader patient populations.
American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S6-S13.
Learn MoreJanuary 14, 2025Clinical Outcomes Article / Publication
As many health plans transition to a value-based diabetes care approach, there is a need for standardized quality measures to assess and benchmark performance. This article addresses key topics to support the adoption of continuous glucose monitoring (CGM) technology in these efforts.
- Transition from Fee-for-Service to Value-Based Care
- Integration of Glucose Management Indicator (GMI) into 2024 NCQA HEDIS Measures
- Impact of CGM on Health Plan Quality Scores & Reimbursement
- Call for Health Systems and Plans to Collaborate with Electronic Health Record Developers
Learn More
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
The Ohio Diabetes Quality Improvement Project (QIP), focused on multisector collaborative approaches, reduced the percentage of patients with A1c >9% from 25% to 20% over two years. In response to barriers voiced by providers and patients, Medicaid payers added coverage for diabetes self-management education and removed prior authorization requirements for continuous glucose monitoring (CGM) within select populations. These efforts enhanced equity to Medicaid enrollees by making it easier to obtain and afford diabetes management supplies and resources.
Learn MoreJanuary 16, 2025Population Health Population Health
In a recent cross-sectional study of electronic health record data, researchers found low rates of CGM prescription orders among Federally Qualified Health Center patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). A total of 1,168 patients with T1D and 35,216 patients with T2D were included. Overall, CGM prescriptions were infrequent, with 11.0% of patients with T1D and 1.0% of patients with T2D receiving a prescription. Disparities in CGM orders were also observed among patients reporting Hispanic ethnicity, Black race, and those who lacked health insurance. Specifically, patients with T1D or T2D who reported Hispanic ethnicity, Black race, or were uninsured had lower multivariable odds of receiving a CGM prescription than White or insured adults (odds ratio [OR], 0.30-0.76). Among patients with T2D, HbA1c values >9.0% (OR, 3.17; 95% CI, 2.37-4.21) and a greater burden of diabetes complications were associated with higher odds of CGM prescription. These findings are of particular interest to managed care and payer stakeholders seeking to identify and address the impact of social determinants of health in vulnerable patient populations.
Wallia A, Agarwal S, Owen AL, et al. Disparities in Continuous Glucose Monitoring Among Patients Receiving Care in Federally Qualified Health Centers. JAMA Netw Open. 2024;7(11):e2445316.
Learn MoreJanuary 16, 2025Clinical Outcomes Guidelines / Policy
The recently issued 2025 ADA Standards of Care offered new guidance supporting CGM use in broader patient populations, the application of CGM metrics in achieving glycemic goals, and the integration of CGM with other diabetes technologies at diagnosis. Specifically, the 2025 Standards of Care recommend considering the use of CGM in adults with T2D NIT to achieve and maintain individualized glycemic goals. Reasserting the clinical value of CGM in type 1 diabetes in pregnancy, the ADA added that CGM may also be beneficial for gestational diabetes and T2D in pregnancy in the 2025 update. ADA also expanded their recommendation for CGM use in individuals with diabetes on any insulin therapy to include youths as well as adults. While previous versions of the Standards of Care stated that CGM metrics should not be used as a substitute for BGM, the 2025 update notes that CGM metrics can be used in conjunction with blood glucose monitoring to achieve glycemic goals. Highlighting the importance of early intervention, the ADA also recommends initiation of CGM, continuous subcutaneous insulin infusion, and automated insulin delivery at diagnosis, depending on a person’s or caregiver’s needs and preferences. These updates are relevant to managed care and payer decision makers in the development of clinically appropriate coverage policies that enhance access to CGM in broader patient populations.
American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S6-S13.
Learn MoreJanuary 14, 2025Clinical Outcomes Article / Publication
As many health plans transition to a value-based diabetes care approach, there is a need for standardized quality measures to assess and benchmark performance. This article addresses key topics to support the adoption of continuous glucose monitoring (CGM) technology in these efforts.
- Transition from Fee-for-Service to Value-Based Care
- Integration of Glucose Management Indicator (GMI) into 2024 NCQA HEDIS Measures
- Impact of CGM on Health Plan Quality Scores & Reimbursement
- Call for Health Systems and Plans to Collaborate with Electronic Health Record Developers
Learn More
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
In a recent cross-sectional study of electronic health record data, researchers found low rates of CGM prescription orders among Federally Qualified Health Center patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). A total of 1,168 patients with T1D and 35,216 patients with T2D were included. Overall, CGM prescriptions were infrequent, with 11.0% of patients with T1D and 1.0% of patients with T2D receiving a prescription. Disparities in CGM orders were also observed among patients reporting Hispanic ethnicity, Black race, and those who lacked health insurance. Specifically, patients with T1D or T2D who reported Hispanic ethnicity, Black race, or were uninsured had lower multivariable odds of receiving a CGM prescription than White or insured adults (odds ratio [OR], 0.30-0.76). Among patients with T2D, HbA1c values >9.0% (OR, 3.17; 95% CI, 2.37-4.21) and a greater burden of diabetes complications were associated with higher odds of CGM prescription. These findings are of particular interest to managed care and payer stakeholders seeking to identify and address the impact of social determinants of health in vulnerable patient populations.
Wallia A, Agarwal S, Owen AL, et al. Disparities in Continuous Glucose Monitoring Among Patients Receiving Care in Federally Qualified Health Centers. JAMA Netw Open. 2024;7(11):e2445316.
Learn MoreJanuary 16, 2025Clinical Outcomes Guidelines / Policy
The recently issued 2025 ADA Standards of Care offered new guidance supporting CGM use in broader patient populations, the application of CGM metrics in achieving glycemic goals, and the integration of CGM with other diabetes technologies at diagnosis. Specifically, the 2025 Standards of Care recommend considering the use of CGM in adults with T2D NIT to achieve and maintain individualized glycemic goals. Reasserting the clinical value of CGM in type 1 diabetes in pregnancy, the ADA added that CGM may also be beneficial for gestational diabetes and T2D in pregnancy in the 2025 update. ADA also expanded their recommendation for CGM use in individuals with diabetes on any insulin therapy to include youths as well as adults. While previous versions of the Standards of Care stated that CGM metrics should not be used as a substitute for BGM, the 2025 update notes that CGM metrics can be used in conjunction with blood glucose monitoring to achieve glycemic goals. Highlighting the importance of early intervention, the ADA also recommends initiation of CGM, continuous subcutaneous insulin infusion, and automated insulin delivery at diagnosis, depending on a person’s or caregiver’s needs and preferences. These updates are relevant to managed care and payer decision makers in the development of clinically appropriate coverage policies that enhance access to CGM in broader patient populations.
American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S6-S13.
Learn MoreJanuary 14, 2025Clinical Outcomes Article / Publication
As many health plans transition to a value-based diabetes care approach, there is a need for standardized quality measures to assess and benchmark performance. This article addresses key topics to support the adoption of continuous glucose monitoring (CGM) technology in these efforts.
- Transition from Fee-for-Service to Value-Based Care
- Integration of Glucose Management Indicator (GMI) into 2024 NCQA HEDIS Measures
- Impact of CGM on Health Plan Quality Scores & Reimbursement
- Call for Health Systems and Plans to Collaborate with Electronic Health Record Developers
Learn More
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
The recently issued 2025 ADA Standards of Care offered new guidance supporting CGM use in broader patient populations, the application of CGM metrics in achieving glycemic goals, and the integration of CGM with other diabetes technologies at diagnosis. Specifically, the 2025 Standards of Care recommend considering the use of CGM in adults with T2D NIT to achieve and maintain individualized glycemic goals. Reasserting the clinical value of CGM in type 1 diabetes in pregnancy, the ADA added that CGM may also be beneficial for gestational diabetes and T2D in pregnancy in the 2025 update. ADA also expanded their recommendation for CGM use in individuals with diabetes on any insulin therapy to include youths as well as adults. While previous versions of the Standards of Care stated that CGM metrics should not be used as a substitute for BGM, the 2025 update notes that CGM metrics can be used in conjunction with blood glucose monitoring to achieve glycemic goals. Highlighting the importance of early intervention, the ADA also recommends initiation of CGM, continuous subcutaneous insulin infusion, and automated insulin delivery at diagnosis, depending on a person’s or caregiver’s needs and preferences. These updates are relevant to managed care and payer decision makers in the development of clinically appropriate coverage policies that enhance access to CGM in broader patient populations.
American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S6-S13.
Learn MoreJanuary 14, 2025Clinical Outcomes Article / Publication
As many health plans transition to a value-based diabetes care approach, there is a need for standardized quality measures to assess and benchmark performance. This article addresses key topics to support the adoption of continuous glucose monitoring (CGM) technology in these efforts.
- Transition from Fee-for-Service to Value-Based Care
- Integration of Glucose Management Indicator (GMI) into 2024 NCQA HEDIS Measures
- Impact of CGM on Health Plan Quality Scores & Reimbursement
- Call for Health Systems and Plans to Collaborate with Electronic Health Record Developers
Learn More
As many health plans transition to a value-based diabetes care approach, there is a need for standardized quality measures to assess and benchmark performance. This article addresses key topics to support the adoption of continuous glucose monitoring (CGM) technology in these efforts.
- Transition from Fee-for-Service to Value-Based Care
- Integration of Glucose Management Indicator (GMI) into 2024 NCQA HEDIS Measures
- Impact of CGM on Health Plan Quality Scores & Reimbursement
- Call for Health Systems and Plans to Collaborate with Electronic Health Record Developers