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Background/Objective: Insurance coverage is cited by both patients and providers as a reason for not prescribing continuous glucose monitors (CGM) to patients with diabetes. Differences in insurance requirements and coverage can introduce bias to prescribing habits of CGM based upon insurance status.
Methods: We aimed to identify existing disparity in CGM access based upon patient insurance. Disparity was defined as rate of CGM access for privately insured patients minus the rate of CGM access for Medicaid insured patients. Using plan-do-study-act cycles, we aimed to reduce the baseline disparity by 10%. Interventions targeted improving provider understanding of requirements for CGM coverage, assisting patients with meeting documentation requirements, and advocating for a change in Medicaidʼs requirements. Data for analysis came from our centerʼs IRB approved Diabetes Registry.
Results: In fall 2020, the initial disparity in CGM access for privately insured vs Medicaid insured patients was 38%. Following initial provider education, a signal of change was seen in October 2020 when the disparity decreased to 25%. With continued effects of interventions described above, by late March 2021, the disparity decreased again to 12%. Advocacy efforts led to a change in Medicaid coverage requirements. Improvement gains held from March 2021 through August 2021.
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