An mHealth vendor is asking the Centers for Medicare and Medicaid Services to reimburse physicians who use devices that can continually monitor a diabetic’s blood sugar levels.

The technology which often pairs a glucose sensor with a smartphone or similar communication platform and connects the patient in real-time with caregivers, is at the forefront of mHealth advances in the treatment of diabetes, which affects some 28 million people in the United States (or 8 percent of the population) and accounts for roughly $245 billion in annual healthcare spending.

In an Oct. 3 letter to CMS Administrator Marilyn Tavenner, Bill Smith, president of ALR Technologies, says continuous glucose monitoring (CGM) technology “may provide clinical benefit to patients on insulin who regularly experience nocturnal hypoglycemia or hypoglycemic unawareness. For these patients, I believe, CGM systems may also provide cost savings to the healthcare system by preventing adverse events.”

The mHealth space in chronic care management is a fast-growing field, with diabetes care one of the larger platforms for innovation. While many care tools now focus on having the diabetic take his or her own blood glucose readings, then enter them into a portal that can be accessed by selected caregivers (including doctors and family members), some of the more innovative companies are developing technology that can automatically measure blood glucose and send that data to a cloud-based portal. Among the front-runners in this field are Telcare, Glooko and Livongo, a new platform being developed by former Allscripts executive Glen Tullman.

Hypoglycemia (or “hypoglycemia unawareness”) occurs when a diabetic’s blood sugar level is dangerously low but unrecognized by the diabetic, and can result in coma and even death if not quickly treated.

Noting that this condition causes some 270,000 hospitalizations each year, Palo Alto, Calif.-based Glooko and the Boston-based Joslin Diabetes Center have partnered to launch the HypoMap, a mobile tool that helps diabetics and their caregivers identify hypoglycemic incidents and move quickly to treat them.

“This isn’t about seeing a patient once or twice a year (and going over the numbers of the past few months); this is about continuous, mobile monitoring,” Glooko CEO Rick Altinger told mHealth News when the partnership was announced in August.

CMS is expected to, on Nov. 1, announce new rules for physician reimbursement on a wide variety of treatments, including chronic care management. According to ALR officials, those proposed rules include a new payment schedule for remote chronic care management. mHealth advocates say better reimbursement for innovative tools and platforms could spur more adoption by providers and consumers alike, improving clinical outcomes and reducing costs.

Richmond, Va.-based ALR Technologies markets the FDA-approved Health e-Connect system, which collects data from blood glucose monitors and uploads that information to a secure website, accessible to care providers.

Smith’s plea targets those with type 1 diabetes, in which the body’s pancreas completely shuts down and patients must monitor their blood sugar and administer insulin when needed – sometimes several times a day. Patients with type 2 diabetes, which often occurs as a result of lifestyle issues (poor diet or exercise habits, weight problems), can sometimes control their condition through behavior changes and oral medicine. For those patients, Smith suggests that CMS reimburse for less costly Internet-based monitoring systems (IBMS) first, then offer CGM if that method doesn’t work.


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