How to Start a Professional CGM Program

Establish genuine need for your Professional CGM Program

Begin by outlining benefits to the people with diabetes, providers and practice. 

• What does your practice hope to gain by implementing this program? 
• Will it solve current problems? 
• Will it help improve the diabetes metrics in your practice? 
• Are you doing all you can to reduce your patient’s HbA1C levels and to optimize their management currently? 

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: 

• Meet with administration and business leaders to discuss challenges and value of a Professional CGM Program 
• Meet with the other providers or diabetes educators to identify current challenges with managing people with diabetes and opportunities to improve. See Worksheet 1 ProWS1

Meet with support staff to identify any concerns they have and obtain their buy-in Identify outcomes of a successful Professional CGM Program, both to people with diabetes and to the practice. See Worksheet 2 ProWS2

QUICK TIP: Reach out to colleagues at other practices with an already established Professional CGM Program and network with them about what worked – and what didn’t go as smoothly as hoped – when getting the program off the ground. Continue to call on them and utilize them as a resource as you create and implement your program. The experience and advice of these key people will be invaluable to you as you move forward. 

FINDING THE RIGHT COMPOSITION OF THE TEAM IS VITAL

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.

CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE

• Identify the members of your team See Worksheet 3 ProWS3
• Define roles and responsibilities of each team member. See Worksheet 4 ProWS4 & Worksheet 5 ProWS5
• Meet as a team regularly
• Seek ongoing feedback from all involved parties 

QUICK TIP:

Anticipate barriers and be prepared to address them. Pay attention to the climate of the team. Seek ongoing ideas from all and don’t be averse to changing direction if warranted. Actively seek to minimize disruption to current workflow. 

Defining the billing process before you begin will help ensure that all potential roadblocks are anticipated, identified and addressed. Make a list of the common insurance payors that your patients may have. Investigate what their policies are surrounding Professional CGM use. Educate staff on the billing codes to utilize for Professional CGM.  

See Worksheet ProWS6  

CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE:

• Identify the team member to be accountable for coordination of insurance benefits and requirements
• Provide an in-service for staff on coding, billing and documentation requirements for Professional CGM Identify team member(s) to perform ongoing coding and billing audits of individuals in the program
• Contact Insurance Company to Obtain Policy Regarding Professional CGM 

QUICK TIP: Mapping out the billing process before you begin will help prevent the delivery of non-covered services. Insurance rules get updated frequently, so you may need to reach out at least annually to determine if any new policies have been put into place surrounding Professional CGM.

Refer to table below to evaluate the features. Both manufacturers provide excellent resources for their devices. 

Things to consider when making your choice of device:

Logging Other Events. Event markers, such as exercise, food intake and medications taken, can be logged in the app with Dexcom when in the unblinded mode. When using the Abbott Freestyle Libre Pro, these events are logged on a paper diary and need to be compared side-by-side with the glucose data download.

Length of Wear. Determine if length of time for sensor wear is important.

Blinded or Unblinded. Determine need for blinded versus unblinded device.

Compare the download reports for ease of interpretation and completeness

Checklist of Items to Accomplish During this Phase:

• Meet with the manufacturer representatives for the devices that you are interested in
• Schedule vendor presentations of devices with members of your team
• Evaluate each vendor for information technology support, customer service and business processes
• Choose a vendor that will support you during the implementation period and beyond

QUICK TIP:

Consider testing both devices to fully understand the processes involved surrounding each of them.

Once you have determined which device you will purchase and stock in your program, you will need to make a contract with the vendor. You will want to address customer service, IT support and other business needs. For example, how many devices do you need? The Abbott Freestyle Libre Pro and Dexcom G6 Pro systems utilize disposable sensors and transmitters along with a multiple use reader. You want to ensure that your inventory items will not expire before they are used.

See Worksheet 8 ProWS 8

CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE

• Determine where you will store your device components
• Identify team member responsible for inventory management and ensuring the device is cleaned and charged before being placed on another patient
• Does software need to be installed for downloading the device? Which computer(s) will you install it on? Do you need approval from your internal IT support?
• Place vendor contact information and customer support contact information in a prominent location for all staff to access as needed
• Estimate the budget required to obtain and maintain device components
• Outline clear and measurable goals for vendor contract. This will be very individual. The support needed (i.e., IT trouble shooting and other issues) is local and depends on the quality of the representative the company has in the area. Make a relationship with that person.

QUICK TIP: Good vendor relations are an important piece of the success of your Professional CGM Program. Meet with your local representative at regularly scheduled intervals. Optimal inventory management will be a vital factor when calculating the ROI (return on investment) of your program.

Staff will need to be trained on patient selection, use/ maintenance of the device, providing instructions to patient, diagnosis/coding/billing, documentation, interpretation and the process for dissemination of results to patient.

See worksheet 9  ProWS9

CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE 

• Develop protocol that lists characteristics that would make individuals most likely to benefit from Professional CGM Set up vendor training sessions for all involved staff 
• Develop staff competencies, so their skills will be documented 
• Set up provider training for diagnosis/coding/ billing, interpretation and documentation of download 

• Start planning annual training refresher now 

QUICK TIP: Providing thorough pre-implementation training will help ensure a smooth start to the program. Solicit staff feedback frequently during and after the training sessions. Consider recording the training sessions so that new staff joining the program in the future will have access to it.

Adding a Professional 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 document the Professional CGM process from start to finish so you have a clear understanding of all steps.

See worksheet 10  ProWS10

CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE

• Seek input from all team members regarding the design of the workflow
• Document visit from beginning to end
• Update existing protocols or document new ones to accommodate this new workflow in daily practice
• Plan for enhanced staffing levels as you roll out the new program
• Provide support and resources surrounding the new workflow
• Solicit staff feedback every step of the way
• Plan for ongoing scheduled evaluation of workflow
• Determine what data you will want to collect ongoing

QUICK TIP:

It is important to consider all perspectives when designing the workflow, including that of the person with diabetes, the support staff and the providers. You may want to appoint a patient representative to assist with design, implementation and evaluation of the workflow to ensure that you fully understand their perspective. As you learn and grow, your program will continue to adjust its workflow

Ensure that all team members are aware of their roles and responsibilities. Proper staff preparation will make sure that the team is on board with the plan and motivated to put in their best effort to help make it a success. Remember to start process evaluation as soon as the implementation stage kicks off.

CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE

• Host a program launch kick-off event and review roles/responsibilities Identify staff “superusers” who can serve as resources to others
• Have vendor and IT available during implementation
• Make device procedure reference materials and troubleshooting guides widely available
• Provide a forum for staff to provide feedback and suggestions
  

QUICK TIP: Keep an open communication line with the team members and involved staff. It is important that the team feels that this is a collective effort and that everyone’s fee

The Professional CGM Program will require frequent and active input from the person with diabetes. It is vitally important to hold a conversation with them that provides education for them about the importance of tracking food intake, exercise and diabetes medication timing. They need to know that the interpretation of the results requires these inputs for best comprehension.

CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE

• Develop a handout which discusses the benefits of Professional CGM and the importance of keeping a log of food intake, activity and diabetes medication See Worksheet 11  ProWS11
• Check insurance benefits for Professional CGM.
• Complete prior authorization with insurance company if needed. Write letter of medical necessity if needed. Most insurance, including Medicare and Medicaid, will cover Professional CGM 2x year – but this number should be known and verified.
• Have person sign consent form for insertion of sensor if needed
• Schedule return appointment for patient to return the sensor and review interpretation with provider. Many individuals will mail back their sensor. Some providers will provide their interpretations via telephone.

QUICK TIP: Make the person with diabetes the centerpiece of the program. Remember that the most prepared person will yield the best interpretation of the data. Spend time up front on education and support to ensure their understanding of the process and goals of the program

You are now ready to try out your new program! All the pieces should be in place. Stress the importance of educating and preparing the patient with the team. 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

• 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 data that you will want to analyze ongoing now
• Walk through the process from start to finish

QUICK TIP: If possible, try to have some cushion in your staffing during this time. This will enable staff to take the time necessary to fully learn and practice the new procedures and processes. Communicate frequently with your support staff to identify any challenges or obstacles to program success. Utilize vendor support and IT support to ensure a smooth implementation

Program evaluation is an ongoing process. Refer often 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. Practice continuous quality improvement. Be thoughtfully and quickly responsive to suggestions/ideas/feedback.

CHECKLIST OF ITEMS TO ACCOMPLISH DURING THIS PHASE

• Compile and sort staff feedback Analyze and evaluate the data that you have collected
• Compare diabetes outcome post-Professional CGM Program to pre-program outcomes If you are not meeting success metrics, reevaluate 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 the device inventory satisfactory?
  

QUICK TIP: Establish a timeline for ongoing program evaluation. A program may not attain the expected measures of success in the first few rounds of evaluation. Staff will become more efficient with the program processes as time goes by. Ease of use will improve, and staff confidence and competence will show ongoing improvements as well.

Planning for the future of your Professional 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 incorporating personal CGM into your practice? Do you want to start working with patients remotely? Do you want to offer an additional CGM product in your program?

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

QUICK TIP: Remember to include administration when planning for the future of the program.