Gaps in Diabetes Patient Education and Rising Healthcare Costs

America's primary care physicians (PCPs) and endocrinologists are struggling to meet the growing demand for diabetes care, with 85% of endocrinologists and 58% of PCPs feeling overwhelmed by the increasing number of patients, according to a new report from CCS.

In collaboration with independent market research firm PureSpectrum, the survey of more than 100 PCPs and 100 endocrinologists highlights the critical gaps in patient education and coaching, which are essential for proper diabetes management.

According to the report, diabetes is one of the biggest challenges to the nation's healthcare system.

More than 11% of American adults are living with a diabetes diagnosis and 38% are categorized as being pre-diabetic. The estimated cost of diagnosed diabetes comes out to $400 billion per year. Government data also projects a shortfall of over 87,000 PCPs by 2037.

Although the importance of ongoing education is known for patients, less than half of those with diabetes receive formal instruction on managing their condition.

In the study, findings displayed that health plans and pharmacy benefit managers (PBMs) are pressuring clinicians to steer patients away from durable medical equipment (DME) companies, which traditionally offer more comprehensive chronic care education and coaching.

While 91% of PCPs report providing diabetes-specific coaching and education, only 65% believe their patients have adequate access. In addition, 86% of endocrinologists and PCPs agree that a lack of ongoing education is a major factor in low patient adherence to therapy.

Proper education and coaching are essential components of diabetes management, according to Arti Masturzo, M.D., chief medical officer at CCS.

“The data is clear: Proper education and coaching are not optional extras — they’re fundamental to successful diabetes management,” Masturzo said. “As we face a projected surge to 39.7 million Americans diagnosed with diabetes by 2030, we must urgently address these systemic gaps in patient support and education.”

One way to close these gaps is through policy changes and incentives that encourage health plans and PBMs to prioritize education-focused care over cost-driven decision-making, Masturzo suggests.

Some potential solutions include outcomes-based contracts between health plans and PBMs that include patient education metrics, CMS-driven incentives that reward improvements such as medication adherence and policy changes requiring PBMs to allocate a percentage of rebates toward patient education initiatives.

In addition, mandates for comprehensive patient education programs specific to technologies such as continuous glucose monitors (CGMs) and financial incentives for health plans implementing comprehensive medication education programs could enhance patient support.

To measure the effectiveness of education programs, Masturzo explained CCS evaluates key performance indicators such as CGM adherence, time in range, projected A1C, reduction of care gaps including preventive screenings, engagement of patients on assessment for social determinants of health, behavioral health, DSMES measures (ADCES7) and patient and healthcare provider satisfaction data.

CCS also focuses on the impact its programs have on overburdened referring physicians, acting as an extension of the care team to defragment chronic care management for patients, providers and health plans.

The benefits of prescribing CGM therapy through DME providers rather than pharmacies are also highlighted in the report.

For instance, 73% of endocrinologists and 69% of PCPs prefer prescribing CGMs through a DME provider because they offer superior health coaching and education.

However, 45% of PCPs and 76% of endocrinologists report feeling pressured by health plans to prescribe through pharmacies instead.

While this is true, 92% of PCPs and 91% of endocrinologists would be more likely to prescribe CGMs through a DME provider if it ensured better patient education and coaching.

To reduce the administrative burden on providers and allow them to focus more on patient education, CCS has built clinical solutions that assist with educating patients on CGM utilization and training care teams to provide the same support directly.

The organization’s predictive analytics platform, PropheSee, also helps keep people on prescribed therapy, while a holistic approach involving coaching on lifestyle changes such as nutrition and exercise ensures that diabetes patients have all the necessary resources to thrive.

Research supports the idea that patients using CGMs have higher therapy adherence and lower overall healthcare costs when they receive their supplies through a DME provider.

Healthcare providers play a crucial role in patient care, fostering trust and long-term relationships with their patients.

Steven Edelman, M.D., professor of medicine at the University of California San Diego, claimed that clinicians should have the authority to make decisions that prioritize patient outcomes rather than being subject to external pressures from health plans.

Ensuring patients have access to the education, resources and support necessary for managing their health is crucial for improving diabetes care in the U.S.