Session spotlight: Understand benefits, challenges of CGMs

PHOENIX – Despite potential headwinds to the medical supplies market, continuous glucose monitors (CGMs) remain a good opportunity, but providers must take a hard look at how well they think they can manage the category, say Matt Edwards and David Chandler. 

Edwards, CEO of GEMCORE, and Chandler, vice president, payer relations at AAHomecare, will co-present during the panel session “Breaking into a new product category: continuous glucose monitors (CGM)” on March 4 at 11:15 a.m. in Room 129 A-B to break down what’s new with the program and what’s at stake.  

HME News: Why are CGMs still a good opportunity for providers? 

Matt Edwards: Regardless of recent CMS policy changes, we are still in the early stages of this technology. While CGMs are widely adopted among people with Type 1 diabetes, penetration within the much larger Type 2 population remains relatively low. That distinction is important because individuals with Type 2 diabetes represent the majority of people living with diabetes overall, and payers are increasingly seeing real-world use cases where CGMs help reduce total health care spending through better outcomes and earlier intervention. 

HME: What questions should providers be asking themselves before getting into the CGM market? 

Edwards: The first question shouldn’t be “Can we sell CGMs?” It should be, “Can we run this well?” CGMs look simple, but they’re operationally demanding. Documentation has to be right. Six-month follow-ups have to be tracked. Reorders must be timely. If any of that breaks down, you’ll feel it quickly in denials, audits or patient satisfaction. 

HME: What are some of the challenges providers need to understand about this market? 

David Chandler: There are different payer considerations, Medicare vs. Medicaid vs. managed care and commercial. Is the coverage channel pharmacy or DME? Do they need to bill with an NCD or other claim requirement? And we can’t do a presentation on CGM and not at least mention competitive bidding. It’s important to know the headwinds and challenges before jumping headfirst into a new product category but knowing where to focus is going to be key to entering this space in the coming years.