CGM
Sonya Collins
More than 38 million U.S. adults have diabetes, according to CDC. The American Diabetes Standards of Care 2024 recommends real-time or intermittently scanned CGM for people with diabetes who require multiple daily insulin injections or continuous subcutaneous insulin injections.
A study by Ballard and colleagues published on April 19, 2024, in Innovations in Pharmacy underscored pharmacists’ qualifications to manage patients using CGM. Patients in the pharmacist-led, federally qualified health center (FQHC)–based pilot program saw reductions in A1C and increases in time in range, while the health center saw an increase in revenue.
When pharmacists provide this service, “It’s efficient for doctors and other providers, beneficial to the patients, who get an additional touch point with their health care, and beneficial to pharmacists, who get to utilize their clinical knowledge to practice at the top or very close to the top of their license,” said Leigh Ballard, PharmD, a coauthor of the study and a PGY1 resident at University of Louisville Health.
Pilot outcomes
Fifteen patients using CGM at Christ Health Center in Birmingham, AL, were followed for 12 months. They attended diabetes-specific visits with a pharmacist in collaboration with an attending physician. In-person follow-up visits to check A1C were scheduled every 3 months, but patients could see the pharmacist between visits as well.
At baseline, patients’ A1C ranged from 7.5% to 12.5%. Their time in range averaged between 16.4% and 61.8%. By completion of the project, patient A1Cs had dropped by an average of two percentage points. Their time in range had increased by nearly ten percentage points. The FQHC received $5,978.54 for the 39 diabetes visits with a pharmacist.
Appointments with a pharmacist
During initial visits with patients, pharmacists taught patients how to apply and use their new CGM device. They helped patients set up and connect CGM accounts with their smartphones and with the clinic’s platform to allow health care providers to pull reports.
For some patients who were especially reluctant to try the new device, “We had them bring in the entire box to their first visit. We placed it on their body for them, so that they didn’t have to do that the first time on their own,” said Jessica Skelly, PharmD, study coauthor and a professor of pharmacy practice at Samford University McWhorter School of Pharmacy in Birmingham, AL.
In subsequent visits, pharmacists discussed the meanings of readings and how patient actions, such as food choices, medication adherence, and physical activity, might have improved those readings or could improve them in the future.
“With real-time data, you’re able to be a little bit more proactive,” said Skelly. “Giving patients the agency to participate, see their data, interface with it and make educated decisions based on that is really valuable and underappreciated.”
New revenue stream
While many patients in the clinic had used CGM before, providers had never formally managed them. Part of the mission of the pilot program was to start billing Medicaid for the visits.
“We were doing this already, so why not try to gain some additional revenue from it?” Skelly said. “It’s not hundreds of thousands of dollars, but when it comes to pharmacist reimbursement in primary care clinics, every little bit helps to sustain these roles.”
The challenge, she noted, was getting the system for billing in place. She recommended working with staff responsible for billing early in the process to ensure that never-before-used CGM codes are built into the system.
Skelly stressed that it’s also critical to get buy-in from clinic leadership and the providers whose patients will be in the CGM program. It’s imperative, she said, that CGM patients’ primary providers are encouraging and enthusiastic about the new service.
At Christ Health Center, buy-in was not a problem.
“We are always trying to find ways to empower our team members, including clinicians, office staff, and medical assistants, to practice at the top of their training and skill sets,” Skelly said.
“Providing people the opportunity to do that makes the entire team more efficient and effective and frees up other providers to focus their attention elsewhere.” ■