September 17, 2024
Clinical Outcomes
Article / Publication

A retrospective claims analysis of 74,679 adults with T2D showed significant reductions in all-cause hospitalizations, acute diabetes-related hospitalizations, and acute diabetes-related emergency room visits associated with CGM use. These sizeable reductions in health care resource utilization were observed in patients treated with non-insulin therapy (NIT; -10.1%, -31.0%, -30.7%), basal insulin therapy (BIT; -13.9%, -47.6%, -28.2%), and prandial insulin therapy (PIT; -22.6%, -52.7%, -36.6%, respectively) across the 6 to 12 month post-index period. Mean HbA1c was likewise reduced across all treatment types at approximately 3 months and sustained throughout the post-index period (NIT, -1.1%; BIT, -1.1%; and PIT, -0.9%; P< 0.0001).Study authors noted that these findings support expanded coverage of CGM use for people with T2D regardless of treatment type to improve glycemic control and reduce hospitalizations and overall health care costs. Furthermore, the study suggests that managed care and payer decision makers can benefit from consideration of CGM use in patients with T2D who are often ineligible for coverage as a means of managing the total cost of care.

Garg SK, Hirsch IB, Repetto E, Snell-Bergeon J, Ulmer B, Perkins C, Bergenstal RM. Impact of continuous glucose monitoring on hospitalizations and glucose control in people with type 2 diabetes: real-world analysis. Diabetes Obes Metab. September 12, 2024. doi: 10.1111/dom.15866. Epub ahead of print.

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September 11, 2024
CGM Technology and Digital Health
CE Activities

Program Description

Patients with diabetes who are hospitalized and have uncontrolled blood glucose levels are at a higher risk for morbidity, mortality, and health care costs. Pharmacists practicing within hospital and health-system settings can identify patients who might benefit from continuous glucose monitoring (CGM) devices. This program will outline responsibilities for health-system pharmacists to improve the integration of CGM into practice for appropriate patients. The panelists will discuss insurance coverage options, potential cost considerations, and the importance of follow-up communication with patients to address initial challenges. Panelists will share their collective experience and discuss opportunities for collaboration to ensure a smooth transition to CGM use after discharge.


Target audience: Health-system and community pharmacists

Type of activity: Application

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September 11, 2024
Clinical Outcomes
Video

This video reviews recent findings on the use of CGM. The studies highlight real world evidence supporting the broader use and
benefit of CGM at the patient and population level. Key takeaways include:

  • The use of CGM has demonstrated clinical utility in non-intensively treated type two diabetes, including individuals using
    non-insulin agents
  • CGM has shown an A1c reduction across diverse population who have historically experienced disparities in access to CGM
  • CGM has demonstrated a clinical value in individuals also utilizing GLP1
  • CGM is linked to reduced mortality in people with type one and type two diabetes using insulin
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August 28, 2024
Population Health
Article / Publication

Clinical practice guidelines endorse the use of CGM, and CMS recently expanded coverage for this technological intervention. However, disparities due to racial/ethnic bias, insurance coverage, and healthcare literacy present barriers to equitable diabetes care and access to CGM. Data show that members of minority populations, those with lower socioeconomic status and those without private insurance are disproportionately affected by diabetes and have lower rates of CGM use. This article, published in Managed Healthcare Executive, notes that payers should place greater emphasis on expanding patient education programs. In addition, further action must be taken to inform patients and to increase adoption and dissemination of new diabetes care technology. In addition to enhancing provider knowledge of CGM and its role in optimal patient care, managed care and payer professionals are tasked with ensuring that unnecessary barriers do not exist in current coverage policies.

In an accompanying video series, Estay Greene, PharmD, MBA, provides insights on ways to improve the care of patients with diabetes from the payer persepective, with a focus on data supporting the use of CGM. Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, FADCES, FCCP, and David Hines also share their perspectives on social determinants of health in diabetes management and overcoming disparities in care with appropriate use of CGM.  

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June 12, 2024
CGM Technology and Digital Health
CE Activities

This Payer IMPACT Brief summarizes the key points of a Satellite Symposium held at the Academy of Managed Care Pharmacy 2024 Annual Meeting.

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June 3, 2024
Population Health
CE Activities

Intended Audience: This activity is designed to meet the educational needs of managed care pharmacy directors, registered nurses, clinical pharmacists, quality directors and medical directors.

Credit Available: Up to 1.0 credit hour available for nurses (ANCC), pharmacists (ACPE), and physicians (AMA PRA Category 1 Credit™)

Expiration Date:  December 31, 2025

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Educational Objectives
After completing this activity, the participant should be better able to:

  • Describe recent updates to HEDIS measures in diabetes care, including opportunities associated with glucose management indicator (GMI) and an increased focus on equity
  • Describe the synergistic impact of CGM and GLP-1 agonists
  • Outline health plan best practices and strategies for streamlined coverage, access, and value of CGM

Expert Faculty

Sean Chitwood, PharmD, MBA

Clinical Pharmacist, Medicare Stars & Clinical Quality
Optum Rx

Fred Goldstein

Moderator

Accountable Health, LLC

Timothy Gilbert, MD

Clinical Endocrinologist

Imperial Health

Maureen Hennessey, PhD, CPCC, CPHQ

SVP, Director of Value Transformation

PRECISIONvalue

Susan Wescott, RPh, MBA

Senior Director of Pharmacy, Managed Care

Mayo Clinic

Jointly provided by Impact Education, LLC, and Medical Education Resources.
This continuing education activity is supported by an independent educational grant from Dexcom, Inc. Medical Affairs.

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May 23, 2024
Coverage and Benefit Design
CGM Best Practices

This podcast episode explores the evolving landscape of payor coverage for diabetes and continuous glucose monitoring (CGM). We delve into key trends and developments in the payor space for diabetes management, how CGM coverage and utilization management have changed, and the recipe for successful partnerships in optimizing diabetes care through CGM. 

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May 17, 2024
CGM Technology and Digital Health
Article / Publication

This article provides a comprehensive summary of the latest discoveries in the category of continuous glucose monitoring (CGM). It compiles the most recent scientific findings in an easy-to-read format, complete with hyperlinks and QR codes to full-text articles and abstracts. Read here to learn how increased implementation and expanded access to CGM may improve clinical and economic outcomes and reduce diabetes-related healthcare utilization and costs.

Key Topics:

  • 2024 Clinical Practice Updates and Quality Measure Changes
  • Emerging Evidence for CGM Use in Non-Intensively Treated Type 2 Diabetes
  • Reduction in Healthcare Resource Utilization and Mortality
  • Real-World Data Showing CGM Reduces Costs
  • Utilization of GLP-1 Agonists in Conjunction with CGM
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May 15, 2024
Coverage and Benefit Design
Article / Publication

A poster presented at the Academy of Managed Care Pharmacy’s (AMCP) annual meeting in New Orleans, LA, shared data from a health initiative by Metro Nashville Public Schools. The employer provided CGM devices as a pharmacy benefit without prior authorization. This policy change led to a two-fold increase in CGM utilization among employees aged 18 to 64 years with T1D and T2D regardless of treatment regimen. The retrospective analysis, covering 184 participants, showed significant improvements in glycemic control associated with CGM use. Specifically, average A1c decreased from 8.7% to 7.9% and from 7.6% to 6.8% among those with T2D treated with insulin and not-treated with insulin, respectively. Additionally, CGM use resulted in a significant improvement in the proportion of individuals meeting the HEDIS and ADA HbA1c targets of <8.0% and <7.0%, respectively. These results underscore the potential benefits of CGM for improving diabetes management through streamlined health care payer and purchaser coverage.

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May 15, 2024
CGM Technology and Digital Health
Article / Publication / CGM Best Practices

The poster outlines best practices for health plan coverage and access to Continuous Glucose Monitoring (CGM) for diabetes management, emphasizing the technology’s transformative impact on care. It recommends aligning coverage criteria with current medical evidence, enhancing utilization oversight, and improving access for underserved populations. Strategies include offering CGM under pharmacy benefits, educating healthcare providers and patients, and developing support systems for at-risk groups. The best practices, derived from expert interviews, a national survey, and a workshop, aim to assist health plan decision makers in optimizing diabetes outcomes and managing healthcare costs efficiently.

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