Inside Pediatrics Summer 2022

Jessica Schmitt, M.D., and Mary Lauren Scott, M.D., initiated a quality improvement project to address disparities in CGM access based on patient insurance. They used plan-do-study-act cycles, aiming to reduce the baseline disparity by 10 percent. The interventions targeted: • improving provider understanding of requirements for CGM coverage • weekly emails to providers detailing the percentage of their patients using CGMs • assisting patients with meeting documentation requirements • providing CGM samples in clinic “Even though the percentage of patients who had CGM samples inserted in the clinic went up, we realized we could not get continued CGM supplies without meeting the Medicaid criteria,” Ashraf said. “In 2020, we petitioned Alabama Medicaid to change the CGM coverage policy, specifically to reverse the demonstrated hypoglycemia requirement to provide CGM technology for our patients with type 1 diabetes.”

In addition to Drs. Jessica Schmitt and Mary Lauren Scott, Drs. Margaret Marks, Joycelyn Atchison and Michael Stalvey joined the effort to petition Alabama Medicaid.

“We explained that the cost of the CGM will be offset by decreased emergency room visits and admissions for diabetic ketoacidosis, hyperglycemia or hypoglycemia. While the yearly cost of CGM per patient may appear high, preventing one patient from having an admission for diabetic ketoacidosis can cover the complete out-of-pocket cost for two to five patients to use a CGM for a year,” Ashraf said. The work was successful. Expanded coverage became a reality on Jan. 1, 2021, when Medicaid eliminated the severe hypoglycemia requirement and approved CGM use for children with type 1 diabetes who had proof of four blood sugar checks per day.

Continuous glucose monitors (CGM) provide real- time, numerical and graphical information every one to five minutes, allowing for blood glucose monitoring with reduced patient burden, plus these devices can be especially helpful to patients with social determinants of health that prevent them from adequately self-monitoring their blood glucose as well as reducing patient and caregiver fear of low blood sugars.

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