2012-P: Developing a New Health Plan Quality Measure: Continuous Glucose Monitoring Utilization for Patients with Diabetes

Introduction and Objective: Continuous Glucose Monitoring (CGM) offers a comprehensive approach to glycemic management for individuals with diabetes. This study evaluated feasibility, data availability and variation in CGM use through the development of a new HEDIS health plan quality measure, Continuous Glucose Monitoring Utilization for Patients With Diabetes. The measure assesses the percentage of individuals ages 18-75 with diabetes who have evidence of CGM use. Methods: Initial testing was conducted using claims and electronic clinical data in OptumLabs Data Warehouse (OLDW) and MerativeTM MarketScan® databases to evaluate the accessibility and feasibility of reporting CGM use and stratification by product line (commercial, Medicaid, Medicare), diabetes type and age. Additional testing will be conducted with health plans in winter 2026. Results: CGM utilization varied by product line, diabetes type and age. Utilization was highest among individuals with type 1 diabetes (62.5% in commercial, 46.0% in Medicare and 46.0% in Medicaid) and lowest among individuals with type 2 diabetes using non-insulin glucose-lowering medications (8.7% in commercial, 10.6% in Medicare and 7.6% in Medicaid). Age stratification showed lower uptake among older adults across all product lines. Data are preliminary, and updates are planned. Conclusion: Database testing indicates that CGM utilization generally aligns with ADA recommendations but remains low among some populations. Overall, findings support the feasibility of implementing CGM utilization as a HEDIS quality measure and highlight opportunities for health plans to support use of CGM. Disclosure E. Hubbard: None. K. Boyd: None. N. Herdzik: None. F.C. Ye: None. J. Morrison: None. E. Jun: None. B. Lin: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust