Medicare’s April 2023 decision to increase coverage for continuous glucose monitoring (CGM) was a major development for diabetes management. Now, with over a million new eligible beneficiaries and many more to follow this year, CGM usage is expected to grow at a record pace – and primary healthcare providers will play a major role.
Before Medicare’s coverage increase, domestic spending on CGMs was approximately $8 billion. However, that amount is expected to double in the next two years. In addition to the promise it holds for improved diabetes management, the expansion provides opportunities for general practitioners to enhance patient care and to help CGM users establish long-lasting, healthy habits.
The best possible outcomes for people with diabetes using continuous glucose monitors will be driven by sustainable changes made through data-driven, personalized care plans. This means facilitating convenient and efficient touchpoints for patients, when and where they need them, in order to emphasize optimizing treatment regimens and individual behaviors. This continuous model of care builds patient-provider relationships based on trust and communication. Primary care doctors are ideally positioned to make this a reality.
Assistive resources are key to primary care CGM utilization
Endocrinologists have been the early adopters of CGM, based on the greater need for frequent glucose testing in their patient population and greater insurance coverage for type 1 diabetes. However, access to specialists is limited for many patients who would otherwise benefit from CGM use. There are no endocrinologists in 75% of U.S. counties, but primary care is available in 96% of U.S. counties. Facilitating CGM access through primary care providers is key to addressing the rise in eligible patients in the face of limited access to endocrinologists. The question is: Do they have the resources to provide this care?
A recent National Library of Medicine survey designed to measure CGM prescription and awareness was administered to over 600 physicians who mostly specialize in family medicine. Findings revealed that doctors are aware of the benefits of CGM and are open to greater adoption by patients. However, the likelihood of that happening appears to be dependent on the availability of assistive resources to support patients in tasks like analyzing and interpreting their CGM data, and making treatment adjustments based on that data. Over 72% of the survey’s respondents indicated they would be moderately or very likely to prescribe a CGM if utilized by patients in conjunction with education, training or workshops, including consultation on insurance issues. Additionally, 63% would feel more assured if patients participated in a one-time consult with an endocrinologist.
Physicians themselves are often interested in the opportunity to become better acquainted with continuous glucose monitors and to receive comprehensive training on how to use them, which is understandable since many had limited experience with CGMs before the Medicare expansion. Some providers might not have the in-practice software to access patient data and there can be an adjustment period in understanding the ambulatory glucose profile reports that CGM systems generate.
The reports serve as a valuable resource for clinical decision support, offering standardized metrics on glucose levels, trends, and areas of concern. Analyzing CGM data helps clinicians gain a comprehensive understanding of glycemic control during various periods of the day as well as inter-day patterns. These assessments provide valuable information on the impact of medications, food, and activity on blood glucose fluctuations. Armed with this knowledge, healthcare providers can identify patients requiring closer monitoring and can determine optimal times for adjusting insulin or other medications as well as targeted lifestyle changes.
Broader care teams, integration tools, and CGM solutions offer support
Encouraging primary care providers who have committed to scaling their practices’ CGM capabilities is imperative. Fortunately, there are many ways the healthcare community can get involved and do their part to contribute to increased usage of this effective treatment.
Easing doctors’ clinical workflows by integrating CGM data into a practice’s existing infrastructure is key, as it saves time by allowing providers to view data without logging into separate systems. Introducing CGM integration with a SMART platform (Substitutable Medical Applications and Reusable Technologies) that builds on Fast Health Interoperability Resources (FHIR) offers decision support capabilities and saves time by allowing providers to enhance operational efficiency.
When a patient’s information is accessible within an EHR, all care team members can visualize the data in the context of relevant clinical factors, like current medications, the latest laboratory results and vitals, and comorbidities. This is especially important as people with diabetes often seek medical care from multiple doctors who need to be on the same page. A management platform that facilitates integration by streamlining data from CGMs and other connected medical devices minimizes prescribers’ CGM-related tasks, empowers them to make personalized treatment recommendations based on data and contributes to the likelihood of improved patient outcomes.
In addition, SMART on FHIR platforms helps practitioners save money that may otherwise be left on the table. While providers can bill Medicare and many payers in the U.S. for reviewing CGM data, many are not taking advantage of the reimbursement opportunity as time constraints deter them from logging into a standalone CGM data portal to find patients, print reports, and upload files to allow proper documentation of their time in the EHR.
Since many doctors expressed a greater inclination to prescribe CGMs when accompanied by educational opportunities and one-time visits with endocrinologists, initiating such measures represents a great option that can be readily facilitated. Endocrinologists and diabetes care and education specialists (DCES) can support multiple primary care practices by offering telehealth appointments or dedicating a few days per month to visit general practitioners’ offices. Embracing novel ways to provide care is essential, as only 36% of primary care providers have a DCES in their practice, even part-time. By bringing resources to the patient, care teams are increasing the odds of successful CGM utilization.
Training sessions, lectures, and webinars are effective tools to boost physicians’ confidence in working with CGMs. Last year, a training program created by clinical pharmacists and implemented in family medicine residency clinics yielded positive results. On knowledge-based assessments, the 21 primary care physicians who participated scored an average of 20.35% before the program and 90.48% at its conclusion.
Now more than ever, enhancing primary care practices to include CGM capabilities is a crucial goal requiring the support and involvement of the broader healthcare community. Providing the best possible care for the influx of new users driven by Medicare’s updated coverage requires convenience, expanded access to educational opportunities, and telehealth visits. The active participation of endocrinologists and diabetes care and education specialists – along with the integration of CGM data into existing clinical workflows and EHRs – improves care coordination and user experiences. Embracing these and other innovative strategies will pave the way for a more effective and comprehensive approach to CGM utilization in primary care settings.
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