How to Start a Professional CGM Program

Identify feasibility of the program through evaluation of your population and of support structures within your practice setting. Begin by outlining benefits to the people with diabetes, providers and practice.

• Are you doing all you can to optimize your patients’ diabetes  management?
• How could personal CGM benefit your patient population?
• Would your patient population be amenable to personal CGM?
• Are the providers in your practice resourced appropriately to support a personal CGM program?
• What does your practice hope to gain by implementing this program?
• How could a personal CGM program add value to your patients, providers and practice?
• Could it help improve the diabetes care provided in your practice?
• Could it help to improve the diabetes metrics in your practice? Once this genuine need is clearly identified, you will know that you are headed in the right direction.
  
  CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE 
  • Categorize your diabetes population by types of diabetes therapies that they utilize.
  • What percent uses multiple daily insulin injections or insulin pumps?
  • What percent uses basal insulin plus orals or other injectables?
  • What percent uses oral agents that may cause hypoglycemia, such as sulfonylureas, etc.?
  • How many are currently utilizing personal CGM devices?
  • Meet with the members of your healthcare team to identify pros and cons of using personal CGM to manage people with diabetes in your practice See Worksheet 1
  • Meet with all important stakeholders (e.g., leadership team ,support staff) to identify any concerns they have and obtain their buy-in
  • Identify outcomes of a successful Personal CGM Program, to people with diabetes, the providers and to the practice See Worksheet 2 

Finding the right composition of the team is vital, and depending on your practice, you will need to decide who should be included on the team.

Enthusiastic and well-qualified team members will ensure a successful launch of the program. In this phase you will need to identify who will be on the team and what their roles will be.

• A diabetes care and education specialist (DCES) is valuable to the team if you have one on your staff. The diabetes care and education specialist can help the individual understand how various lifestyle factors and self-care behaviors affect their diabetes management and possess the knowledge base to offer thorough training on the CGM device to the person with diabetes.
• A pharmacist can provide medication-related expertise, which can add value to a personal CGM program because they can work with the patient and the physician to make adjustments to the treatment plan based on CGM results.
• A person that is knowledgeable in downloading CGM devices will be vital to the team.
• The CGM device company representative may be part of your team to assist with device training and follow-up.
  
  CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE
  • Identify the members of your team See Worksheet 3
  • Define roles and responsibilities of each team member. See Worksheet 4 & Worksheet 5
  • Meet as a team regularly
  • Seek ongoing feedback from all involved parties 

Adding a Personal CGM Program to your practice will require changes to your current workflow. You have already identified the roles of your team members, so you are aware of what new responsibilities they will be taking on. It is helpful to define the Personal CGM process from start to finish so you have a clear understanding of all steps. See Worksheet 6. 

CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE  

• Seek input from all team members regarding the design of the workflow 
• Define the workflow of an in-person visit from beginning to end 
  • Include specifics about patient selection, use of the device, providing education to patient, diagnosis/coding/billing, documentation, downloading and interpreting results 
  • The ADCES Identify-Configure-Collaborate framework provides a standardized 3-step process for integrating diabetes technology into your practice³³. See Worksheet 7 
• Define the workflow of a remote monitoring visit from beginning to end 
• Update existing protocols or create new ones to accommodate this new workflow in daily practice 
• Plan for enhanced staffing levels as you roll out the new program 
• Identify necessary resources that will support the new workflow 
• Solicit staff feedback every step of the way 
• Plan for ongoing scheduled evaluation of workflow and adjust as needed 
• Determine what data you will want to collect ongoing 

Commercial insurance and Medicaid plans vary in regard to amount of coverage for personal CGM devices and their ongoing supplies. Medicare will cover personal CGM if the following criteria are met: 

• Have a diagnosis of diabetes, either type 1 or type 2 
• Use a home blood glucose monitor (BGM) and conduct four or more daily BGM tests
• Treated with insulin with multiple daily injections or a continuous subcutaneous insulin infusion (CSII) pump.
• Require frequent adjustments of the insulin treatment regimen, based on therapeutic CGM test results.

CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE 

• Seek input from all team members regarding the design of the workflow
• Define the workflow of an in-person visit from beginning to end 

Staff will need to be trained on the personal CGM program being offered in your practice. Training should cover an overview of the workflow, including patient selection, use of the device, providing education to patient, diagnosis/coding/billing, documentation34, download and interpretation of results. 

CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE  

• Develop protocol that identifies characteristics of individuals that would most likely benefit from Personal CGM. See Worksheet 9.
• Set up vendor training sessions for all involved staff to learn about the different personal CGM devices and how to download information
• Provide resources for staff about the different routes to obtain Personal CGM (how to pick up the product at pharmacy or obtain from DME supplier)
• Develop staff competencies that are role specific and identify a process to review and document their skills on an ongoing basis
• Set up provider training on program workflow and protocols, diagnosis/coding/billing, interpretation and documentation of downloaded information
• Plan for annual training refresher 

You are now ready to try out your new program! All the pieces should be in place. Solicit feedback and ideas from staff and patients throughout the implementation process. Start tracking success measures at program initiation. 

CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE 

• Walk through the process from start to finish
• Provide on-site technical and product support resources to staff during launch
• Perform frequent check-ins with staff at this beginning phase of the program implementation
• Schedule a weekly staff meeting to discuss how things are going 
• Start collecting any clinical and financial data that you will want to analyze on an ongoing basis 

Program evaluation is an ongoing process. Be thoughtful and quickly responsive to suggestions/ideas/feedback. Continually refer to the metrics of program success that you have identified. Celebrate once you are meeting these success points. If you are not meeting them, determine what the obstacles and challenges are and how you can address or avoid these barriers moving forward. Practice continuous quality improvement. 

CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE 

• Gather staff feedback on a consistent basis
• Survey the persons with diabetes that are being served by this program regarding their satisfaction 
• Analyze and evaluate the clinical and financial data that you have collected
• Compare diabetes outcomes post-Personal CGM Program to pre-program outcomes
• If you are not meeting success metrics, re-evaluate your program process and amend as necessary
• If you are meeting success metrics, disseminate the results widely
• Meet with the entire team to determine next steps. Is program the right size? Does it have the right composition of staff? Is there reasonable access to the program? 

Planning for the future of your Personal CGM program is a crucial component of a successful program. 

• What are the next steps for your program?
• Do you want to establish a satellite location?
• Do you want to start working with patients remotely?
• Do you want to offer a personal CGM support group or annual group education class geared to people who use personal CGM devices?
• Do you want to share your program experience and lessons learned with other care teams?
  CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE
  • Hold a meeting with the entire team to discuss future goals for the program
  • Explore feasibility of goals
  • Market the program to others that may wish to refer to your program