Expanding Access to Continuous Glucose Monitoring in Medicare Patients Receiving Specialty Diabetes Care: A Quality Improvement Project

Abstract

Objective

Despite recent revisions of Medicare coverage guidelines for continuous glucose monitoring (CGM) in 2023, the policy change has been slow to disseminate to providers and patients. This quality improvement project aimed to increase CGM prescriptions and utilization amongst qualifying Medicare patients with diabetes on insulin.

Methods

An interprofessional study team used process mapping to define the baseline state of CGM ordering and opportunities for improvement at a single diabetes specialty clinic. Several interventions were trialed through Plan-Do-Study-Act (PDSA) cycles, including general and targeted provider education, provider-facing technology support documents, a formulary guide, and patient-facing education about the new coverage requirements. The primary outcome was percentage of eligible patients using CGM. Process measures included the number of CGM orders started monthly. Demographic and socioeconomic factors in patients using and not using CGM were measured to assess for differences in prescribing practices.

Results

Over 8 months of intervention, the percentage of eligible Medicare patients using CGM increased from 49.6% to 62.6%. The median number of CGM orders started monthly increased from 34 to 60. Both pre- and postintervention, compared to patients not using CGM, patients using CGM were younger, had lower A1c, and were more often enrolled in the electronic health record patient portal. There were no differences in other demographic factors between the groups.

Conclusion

Quality improvement interventions targeting providers and patients can help translate policy changes into clinical practice. Creating interventions with all patients in mind can prevent new differences in care as innovations are adopted.