Insights with Impact
Impact of Continuous Glucose Monitoring Sourcing on Real-World Adherence and Health Care Costs: A Comparative Analysis by Insurance Type
New research published by CCS in Clinical Diabetes, a peer-reviewed journal of the American Diabetes Association, reveals a critical link between Clinical Glucose Monitor distribution channel and patient outcomes. This groundbreaking research demonstrates that efforts to expand access to CGMs by adding the pharmacy as a new channel for distribution — alongside the established DME provider channel — may be having the opposite intended impact, resulting in lower adherence and higher total costs of care.
Previous studies have shown higher adherence and lower costs with DME providers, but differences between commercial and Medicare Advantage insurance populations have not been examined to date. These latest findings also emphasize that what has historically been viewed as a simple channel decision related to the distribution of medical supplies significantly impacts outcomes and overall healthcare expenditures. Specifically:
- Improved Adherence: Medicare Advantage patients receiving a CGM through a durable medical equipment provider were 22% more adherent after 12 months than those receiving a CGM through the pharmacy channel.
- Lower Total Costs of Care: Among Medicare and Medicare Advantage patients, total costs of care were 35% lower for those using DME providers.
- Reduced Healthcare Utilization: Commercially insured patients using the DME channel had significantly fewer emergency room (ER) and inpatient (IP) days than those utilizing the pharmacy channel (8 days vs. 11 days).
Why America’s Healthcare System Is Failing Patients Living with Diabetes and Providers Alike
To better understand the challenges of clinicians and patients with diabetes, CCS partnered with independent market research firm PureSpectrum to survey 100 practicing PCPs and more than 100 endocrinologists across the United States. The findings reveal a healthcare system under immense strain, with struggling providers, frustrated patients, and systemic inefficiencies that hinder effective care delivery.
This report delves into the root causes of these challenges and explores innovative solutions — such as partnerships with DME providers — that can supplement traditional care models by expanding access to coaching, education, and other patient-centered resources. The major findings include:
- Patient volumes are rising quickly, leading to higher levels of burnout among providers
- Distress is common with the majority of patients expressing despair about their condition
- Gaps in education are making it difficult to engage patients and promote successful therapy
- Systemic barriers, including inefficient pathways for accessing CGMs, create challenges for adherence
A Risk Profile-based Digital Intervention Program to Improve CGM Therapy Adherence
Continuous glucose monitoring (CGM) helps patients with diabetes maintain glycemic control. However, inconsistent CGM use limits its utility. A machine-learning model was developed to identify patients with specific risk factors for CGM non-adherence and guide the design of personalized digital interventions to improve adherence in a sample of patients with diabetes enrolled in Medicare, Medicaid, or commercial plans.
The model analyzed over 150,000 patients with type 1 or type 2 diabetes, identifying three risk categories: patients proactive about health and wellness, health information seekers, and busy caregivers. Targeted emails and text messages sent to lapsed and discontinued patients led to CGM supply reordering in 51.8% of patients contacted. Interventions designed to encourage the resumption of appropriate CGM practices demonstrated success in influencing patient behavior.
Exploring the Impact of Device Sourcing on Real-World Adherence and Cost Implications of CGM in Patients With Diabetes: Retrospective Claims Analysis
The JMIR Diabetes research — Exploring Real-World Adherence and Cost Implications of Continuous Glucose Monitoring in Patients with Diabetes: Impact of Device Sourcing — was conducted by CCS as part of its commitment to defragment and optimize chronic care management for patients and clinicians. The research showed statistically significant insights reinforcing that the benefit channel through which patients access a CGM matters. People using a CGM provided through the medical benefit instead of the pharmacy benefit realized:
- Stronger Adherence to CGM Therapy — Medical benefit had 23% greater adherence;
- A Higher Rate of Therapy Reinitiation in Non-Adherent Patients — Medical benefit was 22%, while pharmacy benefit was only 10%; and
- Lower Average Total Cost of Care — Total medical costs for adherent patients receiving supplies through the pharmacy benefit were 53% greater.
Examining the Impact of Device Sourcing
Patients using a continuous glucose monitoring device can receive supplies from a pharmacy or a durable medical equipment company. We compared CGM adherence rates and healthcare costs between patients who received their CGM devices from a pharmacy or a DME.
The results from these real-world claims analyses suggest that patients who receive their CGM supplies from a DME are more adherent to their device than patients who get their supplies from a pharmacy. In addition, the results suggest that obtaining supplies through a DME places a lesser financial burden on payers and possibly patients.
Turning a Wealth of Information Into Action for Patients
CCS and Accenture are revolutionizing patient care through PropheSee™, an AI-powered predictive model that provides a holistic view of each patient, facilitates more informed decision making and drives effective patient management.
CCS sought a solution that would make their propriety customer data collected over 30 years actionable while addressing a core commitment: reinforcing holistic health and the prevention of co-morbidities so often seen in diabetes patients. CCS joined forces with Accenture to develop a Customer Analytics Record (CAR), essential for providing insights into customer needs and preferences, and an AI-powered predictive model using advanced analytics. This advanced analytics program, PropheSee™, has been a success—helping to improve adherence among targeted, high-risk patient cohorts by as much as 50%.
With its ability to track patient behavior, link the impact of patient characteristics to adherence and predict compliance with treatments, weeks in advance, PropheSee™ delivers intervention programs which keep patients on track, and reduce overall costs. In addition to improved clinical outcomes, health plans and risk-bearing providers can also realize savings of up to US$2,200 per patient per year from an increase in continuous glucose monitoring (CGM) adherence and better glycemic control as well as waste avoidance in CGM setup costs.
Misconceptions and Fragmentation: The State of Diabetes Care in America
CCS partnered with independent market research firm PureSpectrum to survey 1500 individuals living with diabetes who have been prescribed a CGM or Pump and asked their sentiments on everything from how supported they feel to their relationship with their supplier to their view of GLP-1s. Findings include:
- GLP-1 therapy is highly sought after but may not be fully understood. 57% of individuals stated that they think GLP-1 weight loss drugs alone may be a silver bullet for helping achieve their health goals.
- Lapses in clinician communication leave people with diabetes feeling isolated and unsure. Half of people with diabetes only see their doctor three times a year or less, which may contribute to the fact that more than a third of respondents (36%) felt they did not have enough information when first diagnosed with their condition.
- Healthcare consumers living with diabetes are open to innovative relationships to augment care. A majority (94%) believe that suppliers are a critical member of the care team and would like more active engagement with supply companies, including education and coaching.
Reimagining Care Management: Achieving Better Results for People With Diabetes
Comprehensive, proactive care management is crucial for people with chronic conditions, many of whom struggle to navigate the healthcare system while managing their health. However, with the healthcare industry still straddling the line between fee-for-service and value-based care, key care management stakeholders remain misaligned and unable to work together effectively, leaving patients in the shuffle.
This whitepaper outlines how care management stakeholders can acknowledge shortfalls and bridge the gaps in financial, technical, and clinical strategies to support better the health and wellness of people with chronic conditions.