August 11, 2022
Coverage and Benefit Design
Guidelines / Policy

The National Committee for Quality Assurance (NCQA) is revising its Healthcare Effectiveness Data and Information Set (HEDIS) standardized measures assessing plan performance for 2023. Notably, the 2023 dataset will include a new measure related to diabetes management: the risk-adjusted ratio of observed to expected emergency department visits for hypoglycemia among older adults (aged ≥67 years) with diabetes.

This measure reflects a key component of health plan quality pertaining to the management of diabetes, since older adults are more likely to experience severe hypoglycemia, potentially leading to several adverse outcomes: fall-related events and fractures, increased risk of cardiovascular events, and cognitive decline. Similarly, prevailing clinical practice guidelines for the treatment of older adults with diabetes emphasize the prevention of hypoglycemia as an important outcome. The new HEDIS measure provides an opportunity for health plans to identify older members with diabetes who are at highest risk of hypoglycemia and implement preventive interventions and more intensive management.

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July 15, 2022
Clinical Outcomes
Conference Updates

This infographic recaps real-time continuous glucose monitoring (rtCGM) abstracts from the 15th International Conference on Advanced Technologies & Treatments for Diabetes (ATTD 2022) – where innovation in diabetes medicines and treatments, cutting-edge technologies, and the latest research is presented. These abstracts are pertinent to managed care and payer decision makers and help characterize the value of rtCGM in improving clinical outcomes, decreasing avoidable healthcare utilization, and decreasing the burden of diabetes care management.

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July 6, 2022
Coverage and Benefit Design
Economic Outcomes
Conference Updates

Key findings from the symposium at the Academy of Managed Care Pharmacy (AMCP) 2022 Annual Meeting.

Key Takeaways from Dr. Peek:
– rtCGM demonstrated a robust, sustained effect on glycemic control with fewer medications and no increase in insulin doses compared with
blood glucose monitoring (BGM) in the MOBILE RCT
– In the Kaiser analysis, rtCGM initiation reduced healthcare resource utilization for ER/admit due to hypoglycemia by 53%
– Expanded access to rtCGM is warranted based on these findings, particularly in underserved demographics disproportionately affected by
diabetes

Key Takeaways from Dr. Mistry:
– Pharmacy coverage of rtCGM for members with T1 and T2D can result in reduced resource utilization from improvements in clinical
management as well as cost savings for health plans via administrative efficiencies

-rtCGM offers an opportunity for improved outcomes
and proven PMPM savings when covered under the pharmacy benefit

Key Takeaways from Kelly Close:
– CGM represents the single most important tool for improving clinical outcomes and quality of life for people with diabetes
– The lives of people with diabetes have improved exponentially over the past several decades, but continued advancement is possible
with increased access to CGM and the application of more sophisticated measures such as TIR

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

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June 11, 2022
Clinical Outcomes
Article / Publication

In a retrospective claims analysis from Kaiser Permanente of Northern California, 149 patients with insulin-treated type 2 diabetes (T2D; baseline HbA1c <8%) who initiated real-time continuous glucose monitoring (RT-CGM) demonstrated durable glycemic benefit compared with 17,273 noninitiators serving as reference. RT-CGM initiation was associated with decreased HbA1c (-0.06%) while noninitiation was associated with increased HbA1c (+0.32%). A weighted adjusted difference-in-difference model of change in HbA1c yielded a net benefit of -0.30% (P=0.004) for RT-CGM. These findings highlight the notion that RT-CGM may be useful in preventing glycemic deterioration and offer a durable benefit in well-controlled patients with insulin-treated T2D.

Karter AJ, Parker MM, Moffet HH, Gilliam LK, Dlott R. Continuous Glucose Monitor Use Prevents Glycemic Deterioration in Insulin-Treated Patients with Type 2 Diabetes. Diabetes Technol Ther. 2022;24(5):332-337.

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May 19, 2022
Coverage and Benefit Design
Video

The American Diabetes Association (ADA) Standards of Medical Care represent the latest evidence-based recommendations for guiding clinical practice. According to the most recent edition of these guidelines, Level A evidence from the MOBILE study supports the use of real time continuous glucose monitoring (rtCGM) in patients with insulin-treated type 2 diabetes (T2D) regardless of regimen. The findings from the MOBILE study likewise demonstrate the value of rtCGM across typically underserved demographics of patients impacted by social determinants of health (SDOH). Taking the ADA recommendations into consideration, payers are formulating coverage policies that facilitate appropriate access to rtCGM, improved outcomes in T2D, and proven per-member-per-month (PMPM) cost savings. 

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April 28, 2022
CGM Technology and Digital Health
Webinar / Archive

Source: AMCP Science and Innovation Theater Webinar – February 16, 2022

Key Takeaway:

The Dexcom CGM system is unique with the ability to connect with multiple digital health solutions. Combining CGM with digital health apps allows users to quickly see all their data in one place. Access to real-time data can empower people with diabetes and foster patient engagement with in-the-moment diabetes feedback and the opportunity for coaching.

The recently updated American Diabetes Association (ADA) Standards of Care (SOC) 20221 revised the technology recommendations focusing on use of continuous glucose monitoring (CGM). In addition, the ADA added digital health to the recommendations noting the opportunity for digital coaching as a tool for education. Join this webinar for a deep dive into the updated CGM technology SOC and learn about the current evidence that influenced recent changes. Diabetes technology is evolving rapidly, stay up to date with CGM to enhance your knowledge.

1. American Diabetes Association. Diabetes Care. 2022;45(Suppl1):S97-S112

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March 10, 2022
Population Health
Article / Publication

In 2021, NCQA and HL7 hosted the fifth annual Digital Quality Summit (DQS) that convened stakeholders within six distinct “tracks” – each track exploring a different subset of healthcare. Track 6 of the Digital Quality Summit featured five breakout sessions that covered topics such as Continuous Glucose Monitoring (CGM), diabetes distress, digital measurement and measure concepts related to diabetes care, optimal care for individuals with type 1 and type 2 diabetes, NCQA’s own Diabetes Recognition Program, and more.

The Rethinking Diabetes Care in the Digital Age white paper contains findings from track 6 of the Digital Quality Summit and is broken down into the following sections:

1. Importance of Measurement in Diabetes Care beyond HbA1c and Depression

2. Optimal Diabetes Care Management and Continuous Glucose Monitoring

3. Behavioral Aspects in Diabetes Care and Diabetes Distress

4. Health Equity in Diabetes Care Management

5. Driving Improvements in Diabetes Care and the Diabetes Recognition Program

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March 9, 2022
Coverage and Benefit Design
Guidelines / Policy

Source: Center for Health Care Strategies

Published: January 2022

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March 8, 2022
Clinical Outcomes
Economic Outcomes
Article / Publication
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February 3, 2022
Clinical Outcomes
Coverage and Benefit Design
Infographic

Payer Insights Infographic

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