At Helmsley, our Type 1 Diabetes Program is dedicated to helping the global type 1 diabetes (T1D) community live safer, better, and more fulfilling lives today while funding advancements in research and technology for a better tomorrow. A critical piece of achieving that ambitious goal is to improve access to continuous glucose monitoring (CGM) technology, which has revolutionized diabetes management and is now considered standard of care.
CGM devices enable continuous tracking of a person’s blood glucose (blood sugar) levels without the need for finger pricks, alerting them to blood sugar highs and lows outside of the target range via a cell phone app. The results can be shared with loved ones, including partners, parents, or children, and even medical providers, giving peace of mind and a support system that can intervene before blood sugar levels become dangerous or life-threatening for people living with T1D (PLwT1D).
CGM Technology Inaccessible for Many
Despite being standard of care, the barriers between CGMs and the people who need them are real— in fact they are systemic— and to remove them requires a multitude of coordinated and complementary efforts. We looked across sectors and found that barriers range from individual and interpersonal, to community level, up to societal and policy level. This understanding is reflected in our grantmaking approach to increasing CGM access and use.
Pushing for Better Medicaid Coverage
Insurance coverage and one’s income level greatly impact CGM access. Updating Medicaid policies to reflect current best practices in diabetes management is an important step to removing insurance and income barriers.
The Center for Health Care Strategies (CHCS), a non-partisan, evidence-based policy research center, works to improve health outcomes for Medicaid enrollees through policy design and implementation.
With Helmsley support, CHCS published a paper outlining key recommendations for states to expand access to CGM, with complementary calls-to-action for the diabetes community. Building on this, they later launched Accelerating Access to CGMs in Medicaid to Improve Diabetes Care, an initiative supporting states with resources and technical assistance to increase access to CGM for Medicaid beneficiaries living with diabetes, along with additional online tools to support expanded access for Medicaid participants.
Empowering Community Pharmacists to Prescribe CGM
People living with diabetes who take insulin, including PLwT1D, currently need a prescription to use CGM. In most states, that requires an appointment with a medical doctor. The challenge in medically underserved areas is obtaining a timely appointment with a diabetes-informed provider to receive the recommended care for PLwT1D. There is a clear need to increase access to providers who are trained to prescribe and administer CGM.
Approximately 90% of Americans live within five miles of a pharmacy, and according to the CDC, the average person interacts with their community pharmacist 12 times more often than with their primary care provider.
That’s why Helmsley is supporting the American Pharmacists Association (APhA) Foundation to pilot a program for community pharmacists to integrate CGM services (e.g., prescription, initial education, monitoring, and management) into their workflow to help provide care and support people with T1D within their communities. The program launched at 20 community pharmacies in 10 states and includes developing a pharmacist certification program for CGM care. On the policy side, the pilot is addressing pharmacist compensation, so that pharmacists can be reimbursed for this vital service.
If successful, the program could offer a roadmap to support the inclusion of CGM services in the suite of patient care services offered in the community pharmacy setting to increase access to quality diabetes care. This is just one way Helmsley is addressing the endocrinologist shortage. We also currently support projects that aim to provide more resources to other members of care teams, like primary care providers and school nurses, to increase the availability of quality T1D care.
APhA Foundation CGM pilot program participant Goodrich Pharmacy in Minnesota
Closing the Technology Knowledge Gap for Individuals and Providers
Understanding of CGM is another key barrier that must be addressed at both the individual and provider level. This is why we’ve worked with DiabetesWise to help PLwT1D and providers understand the available diabetes technology.
The patient site DiabetesWise and professional site DiabetesWise Pro help visitors to compare available options and combinations of diabetes technology and to navigate insurance coverage. It facilitates discussions between people with diabetes and their providers about what tools best suit their needs. It’s also unbiased and free. The professional tool can be used in clinical practice or at the point of care for decision-making around diabetes management.
This is critical, as not all CGMs are the same. Having a resource like DiabetesWise that shows the different features available in CGMs gives people the information they need to select the one that best fits their lifestyle.
Defining Standards and Quality Measures for Diabetes Digital Technologies
Increased access alone can’t improve outcomes. Clinical outcome measures used to assess glycemic management must evolve to meet advancements in glucose monitoring technology like CGM.
A1C has been the gold standard for assessing a person’s blood sugar level in diabetes for more than 30 years and is still widely used today despite the availability of CGM. A1C reflects an individual’s average blood glucose concentrations over about 3 months, whereas CGM data is practically real time. An average over a long period of time may not adequately inform clinicians and patients of the silent damage caused by intermittent or prolonged spikes of blood sugar out of range.
To address this, National Committee for Quality Assurance (NCQA), in partnership with International Diabetes Center, HealthPartners Institute (IDC), brought together experts in the fields of diabetes focused on quality measurement and health IT. Supported by Helmsley, this convening laid the groundwork for a grant to NCQA to update and expand their measure set that recognizes healthcare providers that deliver quality diabetes care, to allow for digital measure adoption, and to address advancements in glucose monitoring technology.
A Helmsley-supported report from the NCQA and the American Diabetes Association is an important step towards an improved understanding of which diabetes devices best serve specific patient needs. The report focuses on categorization of digital diabetes technologies, provides an assessment framework, and includes recommendations for quality standards and measures. Addressing these areas ensures that the definition of quality diabetes care evolves standard of care to keep up with available technology.
Complex problems require innovative solutions. Helmsley is well-positioned to look across a system and zero in on the multifaceted roadblocks to progress to inform a comprehensive strategy to address an issue. This spirit will continue to inform our efforts to increase CGM access and improve modern diabetes care, because health equity cannot wait, and incrementalism isn’t good enough.
Laurel Koester, MPH, is a Program Officer for the Helmsley Charitable Trust’s Type 1 Diabetes (T1D) Program. She oversees a healthcare models portfolio in which she manages existing grants and identifies innovative models of healthcare delivery with a focus on improving clinical care and outcomes for people with T1D.