The growing importance of quality ratings will put pressure on hospitals to meet ADA standards for insulin therapy without added manpower.
This June, Glytec came to the American Diabetes Association (ADA) Scientific Sessions with a new story to tell. In years past,
Glytec came ADA armed with data showing that eGMS, a cloud-based glycemic management decision support system, offered a superior way for hospitals to manage insulin therapy for patients.1 Company officials brought a new focus to the 77th Scientific Sessions in San Diego, California, saying that it’s not enough to offer better time in range. Glytec wants to show how its results translate into what matters most to payers—and a hospital’s bottom line.
“We know we can get the glucose under control,” said Andrew S. Rhinehart, MD, FACP, CDE, BC-ADM, CDTC, chief medical officer of Glytec. “Now, the issue is: How does that intermediate outcome turn into a hard outcome—lower readmissions?” And that translates into financial savings.
“Does fixing glucose really fix everything else?” Rhinehart asked rhetorically during an interview with Evidence-Based Diabetes Management™ (EBDM™). It turns out that stabilizing blood glucose levels can fix a lot of things, leading to shorter hospital stays, fewer readmissions, and lower infection rates among patients—all factors that hospitals are graded on in this era of value-based care.
Rhinehart credited the shift in strategy to Raymie McFarland, vice president of Quality Initiatives and Clinical Excellence, who previously led quality improvement processes for Sanofi. Glytec’s FDA-cleared algorithm suite, known as Glucommander, can assist providers with glycemic management at all points on the continuum of care, which will be increasingly important as health systems work to comply with the Medicare Access and CHIP Reauthorization Act (MACRA).
The growing importance of quality ratings will put pressure on hospitals to meet ADA standards without extra manpower. As a practical matter, there aren’t enough endocrinologists to meet demand, due to lagging incomes in the field and a rise in the number of people who need these specialists. “As the market moves toward value-based reimbursement, we’re there—we’re ready for it,” Rhinehart said.
Robby Booth, senior vice president of Research and Development at Glytec, noted a distinguishing feature: Glucommander can interact with major electronic health record systems, a hurdle that has kept many digital providers from making headway. (Glytec has reported case studies involving integration with Epic Healthcare Solutions, which is used by many of Booth’s clients.2)
Partnerships Are Key
In an interview with EBDM™, Booth said that Glytec has formed key partnerships with other technology companies—AgaMatrix, maker of a Bluetooth glucose meter, as well as Livongo and Telcare, which make cellular meters—to capture glucose data from the cloud. Glytec has shown that, instead of needing 18 months’ worth of appointments to help patients reach their glycated hemoglobin goal, physicians can use the system to titrate patients in 11 or 12 days.
“We want to be able to get that patient titrated to goal as quickly as possible,” Booth said. “[To be] able to do that remotely, it’s really critical to have that data from the patient [who] is testing in the home environment.”
The gradual development of skill sets, from the early focus on critical care patients to the ability to help care for noncritical patients, has positioned Glytec for growth as MACRA arrives. “After 11 years, we’re an overnight success,” Booth said.
Results From the Kaweah Delta Medical Center
Showing how glycemic management fits into a quality care strategy offers a context for the results Glytec presented at ADA, McFarland said.
A decade ago, the ADA called for hospitals to shift from sliding scale to subcutaneous basal-bolus insulin therapy for non—critically ill patients. However, concerns that staff could not keep up with the dosing demands kept most hospitals from upgrading to the standard of care.
Earlier in 2017, Glytec presented data highlighting how eGMS offered hospitals a way to meet the basal-bolus standard, reducing the number of days patients were out of range.3 At the June ADA meeting, Glytec offered proof that the system not only improves glycemic control but also saves time and money.4 The data came from Kaweah Delta Medical Center in Tulare County, California, where 13.2% of the county has diabetes. After struggling to convert to basal-bolus insulin, the hospital succeeded with help from Glucommander, an electronic-guided insulin dosing system.
In 2015, researchers matched 1039 patients who received usual care with 3200 patients treated during the first year after the switch to eGMS (March 2016 to March 2017). The results showed an overall savings in the first year of $7.1 million, including $2.6 million achieved by cutting the average length of stay from 7.18 days to 5.51 days.
The share of patients with hypoglycemia (<70 mg/dL) was lower with Glucommander (20.10%) than with usual care (30.31%), even though the Glucommander brought a reduction of 69,256 insulin adjustments. The calculated time saved per patient was nearly 200 minutes; the time saved per shift, 30 minutes.
Before the hospital implemented the Glytec system, basal-bolus insulin was used only 5% of the time; afterward, the situation was reversed, with basal-bolus used 96% of the time—particularly noteworthy, given how much the hospital had struggled to make the switch before engaging Glytec, McFarland said. While basal-bolus is the standard of care, “it’s difficult to do this for every patient with no endocrinology support,” he said.
Christina Mattina contributed to this report.
1. Caffrey M. Glytec presents evidence on how using data to deliver insulin improves outcomes. The American Journal of Managed Care™ website. ajmc.com/conferences/ada2016/glytec-presentsevidence- how-using-data-to-deliver-insulin-improves-outcomes. Published June 20, 2016. Accessed August 9, 2017.
2. Chidester P. Integration and patient care success: a case study using an integrated glycemic management system (GMS). Presented at: The American Hospital Association Leadership Summit; June 20-22, 2014; San Diego, CA. https://www.glytecsystems.com/Evidence/integration-andpatient- care-success-a-case-study-using-an-integrated-glycemic-management-system-gms.html. Accessed June 21, 2017.
3. Aloi J, Ullal J, Chidester P, McFarland R. AUTO: AUtomatic Titration tO Target: subcutaneous basalbolus insulin management using eGMS in the non-ICU setting. Presented at: American Association of Clinical Endocrinologists (AACE) Annual Clinical and Scientific Congress; May 4, 2017; Austin, TX. glytecsystems.com/Evidence/auto-study-automatic-titration-to-target-subcutaneous-basal-bolusinsulin- management-using-egms-in-the-non-icu-setting.html.
4. Newsom R, Patty C, Camarena E, Gray T, Sawyer R. Safely eliminating sliding scale through a hospital wide conversion to basal/bolus insulin vs implementation of an electronic glycemic management system. Presented at: 77th Scientific Sessions of the American Diabetes Association; June 9-13, 2017; San Diego, CA. Abstract 133-LB. abstractsonline.com/pp8/#!/4297/ presentation/45932.