Population Health
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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Intended Audience: This activity is designed to meet the education needs of managed are 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
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
Clinical Pharmacist, Medicare Stars & Clinical Quality
Optum Rx
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.
This infographic highlights the value of CGM for positively impacting diabetes care quality, with special consideration given to underserved demographics of patients based on race/ethnicity and age. The piece links to the 2023 AMCP symposium moderated by Dr. Gary Puckrein, President and Chief Executive Officer of the National Minority Quality Forum, where diabetes care disparities and quality were also brought into focus. Also linked is an expert interview with Diana Isaacs, PharmD, with insights on disparities in diabetes care and quality considerations. Guidance is offered on improving CGM access as a means for meeting recent HEDIS quality measures tied to reducing emergency department and hospital use. Using findings from Blue Cross Blue Shield North Carolina as a case study, the infographic serves as a call-to-action for payers to remove manual prior authorizations for CGM under the pharmacy benefit.
Despite Medicare making strides toward improving access with expanded coverage criteria in recent years, experts in the field of endocrinology are speaking out on the importance of reaching underserved populations with the “potentially life-changing benefits” of CGM technology. In addition to expanded coverage eligibility, Richard M. Bergenstal, MD, noted that access to CGM must be simplified by making the technology more readily available in clinic and community settings. To support these efforts, Irl B. Hirsch, MD, called on the role of patient and provider education for driving appropriate uptake and utilization. Managed care and payer professionals will find these expert insights valuable for addressing disparities in diabetes care and outcomes among members affected by SDOH.
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Intended Audience: This activity is designed to meet the educational needs of medical directors, registered nurses, pharmacy directors, clinical pharmacists, specialty pharmacists, quality directors, as well as network physicians affiliated with various MCOs, health systems, and other payer organizations.
Credit Available: Up to 0.5 credit hour available for nurses (ANCC), pharmacists (ACPE), and physicians (AMA PRA Category 1 Credit™)
Expired
Click here to review- CE ExpiredEducational Objectives
After completing this activity, the participant should be better able to:
- Describe the clinical outcomes of real-time continuous glucose monitoring initiation in insulin-treated patients with diabetes
- Access health plan opportunities to improve diabetes outcomes for patients with diabetes based on current treatment guidelines and quality measures
- Identify how multi-disciplinary care teams can support quality improvement interventions for patients with diabetes
Expert Faculty
Jointly provided by Impact Education, LLC, and Medical Education Resources.
This continuing education activity is supported by an independent educational grant from Dexcom, Inc.
Intended Audience: This activity is designed to meet the educational needs of medical directors, registered nurses, pharmacy directors, clinical pharmacists, specialty pharmacists, quality directors, as well as network physicians affiliated with various MCOs, health systems, and other payer organizations.
Credit Available: Up to 0.5 credit hour available for nurses (ANCC), pharmacists (ACPE), and physicians (AMA PRA Category 1 Credit™)
Expired
Click here to review – CE ExpiredEducational Objectives
After completing this activity, the participant should be better able to:
- Describe the risks of hypoglycemia in older patients with diabetes
- Access health plan opportunities to identify underserved populations with diabetes, address the risks of hypoglycemia, and to implement appropriate interventions for prevention of hypoglycemia in high-risk populations
- Identify steps for the delivery of successful quality improvement interventions in diabetes and the role of real-time continuous glucose monitoring
Expert Faculty
Jointly provided by Impact Education, LLC, and Medical Education Resources.
This continuing education activity is supported by an independent educational grant from Dexcom, Inc.
According to a survey administered by Employee Benefit News, at least 70% of employees find high stress, depression, asthma, or diabetes disruptive enough to affect their everyday lives, including work and other responsibilities. In response, the vast majority of employers (84%) are offering digital health tools in some form that can help employees manage common chronic conditions, although only an average of 50% of employees take advantage of these benefits. Research shows employees want flexible options that offer new innovative tools to treat their chronic conditions, in addition to education to help them get started with a new program. Third-party technology vendors can assist in driving employee engagement, mitigating rising health care costs, and creating better outcomes for employees. Managed care and payer professionals will find these insights useful for developing programs that offer value to purchasers of health care.
“Optimizing Digital Health Tools to Retain and Engage Employees.” Employee Benefit News Supplement.
Learn MoreIn an interview with OBG Management, Dr. Celeste Durnwald explains the benefits of real-time continuous glucose monitoring (RT-CGM) in pregnancy. Risk to fetal, neonatal, and maternal well-being is increased in pregnancy complicated by diabetes. While most patients obtain 7 to 8 glucose values over 24 hours with self-monitoring of blood glucose (SMBG), RT-CGM collects approximately 288 readings daily. In this manner, RT-CGM may help pregnant women align their carbohydrate intake and insulin dosing throughout the day to prevent hyperglycemia while avoiding sudden hypoglycemic events, all without the burden of finger sticks. The CONCEPTT trial showed that only 6 patients would need to use RT-CGM to prevent 1 large-for-gestational-age infant, 8 patients to prevent a case of neonatal hypoglycemia, and 6 patients to prevent a neonatal intensive care unit (NICU) stay. Based on these findings and other published literature, consensus guidelines recommend the use of RT-CGM in pregnant women with pre-existing type 1 and type 2 diabetes, as well as in those with gestational diabetes. These findings offer insights for payer professionals seeking to implement evidence-based quality improvement programs in diabetes or obstetrics.
Durnwald CP. Real-Time Continuous Glucose Monitoring Use in Pregnant Patients From A-to-Z. OBG Management. August 2022.
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