Episode Overview

Podcast: AACE Podcasts
Episode 69: Expanding Access to Continuous Glucose Monitoring in Medicare Patients Receiving Specialty Diabetes Care: A Quality Improvement Project
Release Date: October 17, 2025
Host: Dr. Cecilia Lansing
Guest: Dr. Kristin Flint

This episode dives into a quality improvement (QI) project focused on increasing access to continuous glucose monitoring (CGM) for Medicare patients with type 2 diabetes at a major academic diabetes clinic. Dr. Kristin Flint shares her team’s strategies, the structure of their QI initiative, the impact of 2023 Medicare policy changes, and practical insights for clinics wishing to replicate similar improvements in access and utilization. The conversation covers implementation tactics, provider and patient engagement, and lessons learned from a demographic standpoint.

Key Discussion Points & Insights

1. Clinic Structure and QI Framework [01:29-04:27]

• Clinic Staffing & Organization:
  • 34 MD/NP providers (27 MDs, 7 NPs), 3 nurses, 2 medical assistants, a dietitian, and several patient services coordinators.
  • 4–8 endocrinology fellows/year, with providers varying in clinical/research focus.
  • Size and workflow complexity made change management challenging, emphasizing the need for stakeholder engagement.
• Reason for the Project:
  • Prompted by the 2023 Medicare expansion for CGM coverage to all insulin-treated diabetes patients.
  • CGM coverage (as DME) mostly managed by medical assistants, though many providers were unaware of specific processes.
• QI Methodology:
  • Used Plan-Do-Study-Act (PDSA) cycles.
  • Project team included 4 MDs, 1 NP, and both medical assistants for comprehensive perspective.
  • Developed interventions across all role groups: two for providers, one for patients, two for nursing/admin staff.

Notable Quote:
"When we started planning our PDSA cycles, it was critical to involve people from all the different role groups so that we could really understand our baseline state and create reasonable interventions." — Dr. Flint [03:45]

2. Patient Selection & Eligibility Criteria [04:51-07:20]

• Inspiration & Eligibility:
  • Sparked in Dr. Flint’s fellowship by a preceptor’s reminder about Medicare changes.
  • Previously, only those checking blood sugars multiple times a day and taking multiple daily insulin injections were eligible (since 2017).
  • 2023 Policy Update: Expanded to all insulin-treated diabetic patients, notably those with type 2 diabetes on any insulin.
  • Project Inclusion Criteria: Patients with type 2 diabetes, any insulin use, and Medicare as primary/secondary insurance.
  • Exclusions: Patients with type 1 diabetes (coverage unchanged).
• Data Collection:
  • Used EMR registry and chart reviews to identify eligible patients and baseline CGM use.
  • Open cohort: Eligible patient population changed over time.

3. Provider and Stakeholder Engagement [07:20-11:19]

• Provider Targeting:
  • Initial project focused on diabetes clinic providers, with a separate effort for primary care (published elsewhere).
  • Two interventions for providers:
    • General education at monthly meetings with a process map overview.
    • Follow-up emails with personalized patient lists (eligible but not on CGM).
  • No expectation for action: Providers free to respond or not.

Notable Quote:
"We let everybody know that there were no expectations around this email... Providers could really engage with the lists as they chose. We were really curious to see if just sending the targeted lists would help raise awareness." — Dr. Flint [09:30]

• Reactions:
  • Out of 27 MDs, 12 responded.
  • 5 appreciated actionable lists, 2 reached out to patients directly, 5 clarified patients were not good CGM candidates.
  • Active engagement from nearly half was seen as evidence for the effectiveness of targeted education over passive general education.

4. Baseline CGM Utilization and Interpretation [11:19-12:51]

• Baseline Use: 49.6%
• Data Accuracy Challenges:
  • Initial EMR prescription data underestimated actual CGM use (durable medical equipment orders not always captured).
  • Realization after thorough chart review that utilization was much higher.
• Interpretation:
  • Specialty clinic patients more likely to qualify and have resources for advanced technology.
  • Both surprise (low initial number) and satisfaction (actual near-50% adoption).

5. Intervention Summary and Outcomes [13:21-16:43]

• Post-Intervention CGM Use: Increased to 62.6%
• Five Key Interventions:
  1. General Provider Education: Monthly meeting, process mapping.
  2. Targeted Provider Education: Individualized patient lists.
  3. Provider Support Documents: FAQ sheets for rapid reference, handouts, and patient portal messages.
  4. Formulary Guide Updates: Added CGM coverage details across insurance types, updated annually, widely shared.
  5. Patient Education: Flyers in English and top five local languages, simple reading levels, encouraged patient-driven inquiry.

Memorable Explanation:
"We really wanted a belt and suspenders approach. Hopefully the provider is talking about CGM with the patient, but we wanted to empower the patient to bring it up with the provider as well." — Dr. Flint [15:51]

6. Sustained & Most Effective Interventions [16:43-18:48]

• Long-Term Impact:
  • Provider support documents and the enhanced formulary guide have had the most enduring uptake.
  • Materials now used beyond diabetes specialty clinic (e.g., primary care).
  • Durable education resources drive ongoing adoption and efficiency.

7. Addressing Sociodemographic Disparities [18:48-20:40]

• Findings:
  • “We didn’t see significant differences based on sociodemographic factors between patients who were using CGM or not using CGM.” [19:22]
  • Dr. Flint suspects equal access at the specialty clinic level, but disparities may exist upstream in specialty clinic entry.
  • Interventions deliberately written at 6th-grade reading level and translated into the top five local languages for inclusion.

8. Practical Takeaways for Listeners [21:03-21:46]

• QI as Translational Bridge:
  • Local QI projects can quickly implement policy changes and tailor interventions to specific practice environments.
• Stakeholder Inclusion:
  • Engage all clinic roles for better design and buy-in.
• Equity Consideration:
  • Interventions must avoid worsening existing disparities as technology and policy evolve.

Closing Quote:
"Quality improvement projects can really bridge the translational gap between clinical research and healthcare delivery. This kind of work can help implement policy changes rapidly..." — Dr. Flint [21:03]

Notable Quotes & Memorable Moments

• “Our interventions were designed to build upon each other and avoid losing momentum with this cultural change within the clinic.” — Dr. Flint [16:59]
• “Having that document available can speed up data download and sharing.” — Dr. Flint [17:37]
• “All of our documents were written at a 6th grade reading level and we translated all of the patient facing documents into the top five languages...” — Dr. Flint [20:15]

Timeline of Important Segments

| Timestamp | Segment/Topic | |-----------|----------------------------------------------------------------------| | 01:29 | Clinic structure and QI planning | | 04:43 | Site selection and project focus | | 05:10 | Patient selection and evolving Medicare policy | | 08:02 | Provider engagement and response to interventions | | 11:19 | Discussion of baseline CGM utilization | | 13:21 | Overview of five interventions | | 16:43 | Assessment of intervention effectiveness and sustainability | | 18:48 | Sociodemographic differences and translation efforts | | 21:03 | Closing QI lessons and final take-home messages |

Summary for Clinicians and Listeners

This episode offers a practical case study on successfully expanding CGM access to an under-reached population—Medicare patients with type 2 diabetes—by aligning clinic workflow, targeted education, patient empowerment, and up-to-date resources. The methodology and insights shared by Dr. Flint are broadly applicable to similar specialty or primary care settings. Sustained results depended on durable educational tools and consistent, multi-level engagement, all implemented through an equity-focused lens.

Listeners, especially those in diabetes or chronic care management, will gain both a blueprint for system redesign and critical reminders on the importance of stakeholder and patient-centered approaches in quality improvement.