How One MA Plan Prioritized SDOH to Improve Diabetes Care Access

Health plans must look beyond clinical outcomes and address social determinants of health to improve beneficiaries’ health. Zing Health, an Illinois-based Medicare Advantage plan, did just that for beneficiaries living with diabetes.

The health plan was established with the goal of identifying social determinants of health and addressing disparities among its member population, Estay Greene, vice president of pharmacy at Zing Health, told HealthPayerIntelligence.

Specifically, the Medicare Advantage plan leveraged continuous glucose monitors to help beneficiaries overcome barriers to accessing diabetes care.

When Greene joined the plan a little over two years ago, less than one percent of beneficiaries with diabetes were receiving continuous glucose monitors.

Using continuous glucose monitors as an alternative to traditional finger stick tests can offer several benefits. Continuous glucose monitors track a user’s blood glucose levels every few minutes. Depending on the device, it can predict where the user’s levels will be in the next 10 to 15 minutes and help prevent dangerous fluctuations, Greene said.

In addition to being painful, finger stick tests can be time-consuming. The recommendation is for users to test eight times per day with this method.

“Getting a member to do that eight times a day doesn’t occur. They’re probably doing it whenever they experience those signs and symptoms before they give an insulin injection. About four times a day is the best-case scenario you get, and that causes all those fluctuations and maybe a little poorer management of the disease state,” Greene explained.

While continuous glucose monitors can help improve health outcomes, beneficiaries have experienced challenges accessing them.

“Typically, these are covered under durable medical equipment benefits for Medicare. That means you get it from a provider, and they usually ship it to your home like a normal Amazon package would arrive at your doorstep,” Greene stated.

“Because we’re serving a lot of people in urban areas, some durable medical equipment providers wouldn’t ship to the home because they were afraid members wouldn’t receive it. Some of our members were concerned about that as well, that even if it got dropped at their doorstep…by the time they’d get there, the package might be gone.”

To combat this challenge, Zing Health allowed beneficiaries to pick up continuous glucose monitors with other diabetes medications at their local pharmacy. Additionally, the health plan worked with its providers to ensure beneficiaries could access the monitors in a way that supported utilization management, Greene mentioned.

Cost was another barrier beneficiaries faced when accessing continuous glucose monitors. Under the durable medical equipment benefit in traditional Medicare, beneficiaries must pay 20 percent of the cost, ranging from $300 to $600 per year.

“That can become a roadblock to a lot of members receiving these devices,” Greene indicated.

“Whenever we provided access at the pharmacy counter, our costs went down. We provided those cost savings to our membership so that they would pay zero cost whenever they would receive these continuous glucose monitors at the pharmacy counter to facilitate that access and remove the financial barrier of receiving the devices.”

Addressing these social determinants of health helped increase continuous glucose monitor utilization among Zing Health’s member population. By the end of 2022, 30 percent of insulin users had started using a continuous glucose monitor, Greene shared.

After removing the barriers of access and cost, the health plan had to ensure beneficiaries knew how to properly use the device and share the information with their provider. Zing Health leveraged community health workers to overcome this challenge.

“Our community health workers went into the member’s home while on a livestream at the same time with a pharmacist from our end and made sure that the member knew how to apply the device, use it, and set it up,” Greene explained.

Beneficiaries can use a reader made by the company with the continuous glucose monitors or their smartphone. For those who did not have access to a smartphone, the health plan helped provide them with a reader. By sending community health workers into homes, the plan was able to identify and solve obstacles for beneficiaries.

The community health workers also helped beneficiaries learn how to give their providers and Zing Health pharmacists real-time access to their continuous glucose monitor readings. With this information, the pharmacists can share whether beneficiaries need new medication or should change their doses.

In addition to reducing barriers to continuous glucose monitors, Zing Health facilitated access to zero-cost insulin products.

“We’ve removed that barrier for the CGM and the insulin, so a person can get the appropriate therapy and be appropriately monitored at zero cost to make sure that they can keep their blood sugars in check, which should prevent some other issues such as leg amputations or going blind. Those types of things are what we’re trying to prevent by eliminating those cost barriers,” Greene concluded.