By Steve Wheeler, VP of Partnership at Tenovi—After more than a decade in remote healthcare, I have come to believe that one of the biggest barriers to better diabetes monitoring is not technology. It is how we pay for it.
Why is Diabetes Being Overlooked in Remote Patient Monitoring?
In more than 10 years working in remote healthcare, one thing has consistently stood out to me: hypertension gets much of the attention in remote patient monitoring (RPM), while diabetes, arguably one of the conditions that could benefit most from sustained monitoring, often takes a back seat. I understand why. Blood pressure programs are relatively simple to launch, the equipment is affordable, and the economics are easier to manage. But diabetes is a different proposition. And I think the industry has been approaching it the wrong way.
The United States has approximately 40 million people living with diabetes, according to the CDC. Among adults 65 and older, prevalence approaches 29%. These are patients who may need ongoing support with glucose management, medications, diet, and other chronic conditions, often including hypertension. For some, managing diabetes involves checking glucose levels several times a day. Poor control can lead to serious complications affecting the kidneys, eyes, nerves, and cardiovascular system.
The need for better management is clear. So why aren’t we seeing more emphasis on diabetes in Medicare RPM programs?
The Problem Is Not Just the Cost of Diabetes Testing Supplies
When I talk with organizations about diabetes RPM, testing supply costs are a recurring concern. Unlike blood pressure monitoring, where a connected cuff can be used repeatedly without consumables, traditional blood glucose monitoring requires a continuing supply of test strips and lancets. For a healthcare organization managing a large patient population, those costs matter.
But here is the part I think gets overlooked: Medicare already covers eligible blood glucose monitors and diabetes testing supplies through either Pharmacy (PBM) benefit or its durable medical equipment (DME) benefit. Meanwhile, RPM programs operate under a separate reimbursement structure, with payment rates that generally do not vary based on the condition or type of device being monitored.
When an RPM provider supplies its own glucose meter and diabetes testing supplies outside the traditional DME benefit, those ongoing expenses can become part of the cost of delivering the RPM program. Depending on the arrangement, those costs may ultimately fall on the physician practice. That can make diabetes less attractive financially than hypertension, even when the patient could benefit from more intensive monitoring.
From my experience, the distinction between existing insurance benefits for diabetes supplies and the economics of RPM is not always well understood. We are already paying for parts of diabetes care. We need to get better at making those parts work together.
A Better Model Starts with What’s Already Covered
I see an opportunity for RPM providers to work more closely with established diabetes equipment suppliers and manufacturers. Rather than assuming every connected glucose monitoring program needs to carry the full cost of diabetes testing supplies within its RPM economics, we should be exploring ways to coordinate eligible PBM/DME covered supplies with remote monitoring services.
The details matter. Device eligibility, supplier relationships, billing requirements, and patient coverage all have to be addressed properly. There is not a simple one-size-fits-all solution. But I believe this is a more productive direction than continuing to treat diabetes as an inherently expensive RPM condition.
At Tenovi, we have spent years working to make connected monitoring easier for patients and healthcare organizations. Reliable cellular transmission removes much of the work involved in getting readings from the patient’s home to the care team. That is important, but it only solves the technology side of the problem.
If we want more patients with diabetes to benefit from RPM, we also have to solve the economics of delivering it.
Diabetes Requires More Than a Monthly Reading
Another reason I think diabetes deserves more attention is that monitoring is only part of managing the disease. Glucose readings help identify patterns, but patients also need education, medication management, nutritional guidance, and consistent clinical follow-up. Those needs do not necessarily disappear once a patient’s numbers improve. A person with hypertension whose blood pressure has stabilized may eventually need less intensive monitoring.
Diabetes, particularly in patients with complicated or poorly controlled disease, can require much more sustained attention. That does not mean every patient should remain enrolled in RPM indefinitely. It means the duration and intensity of monitoring should reflect the patient’s condition rather than an arbitrary program timeline. It also means we should be thinking about how RPM works alongside diabetes education and other appropriate care management services, rather than treating it as a standalone device program.
Value-Based Care Should Change Conversation
This is where I see the biggest opportunity over the next several years. As healthcare moves further toward value-based care, organizations will have more reason to evaluate chronic disease programs based on their results rather than simply the cost of delivering a reimbursable service. Diabetes is particularly well suited to that discussion because we have established clinical measures, including hemoglobin A1c (HbA1c), that help assess glucose management over time.
We can follow whether patients are improving, whether treatment is working, and where additional intervention may be needed. Better glycemic management can reduce the risk of certain long-term complications, although demonstrating financial savings from RPM requires more than a change in HbA1c alone.
My view is that diabetes RPM should be supported by reimbursement that better reflects the additional resources required for complex patients, along with the flexibility to monitor those patients for longer periods when clinically appropriate. Managing diabetes can demand more time, more education, and more frequent intervention than managing uncomplicated hypertension. Our payment models should recognize that difference.
It is Time to Reconsider Our Priorities
I am not suggesting we move away from hypertension. It is an important part of RPM, and many patients with diabetes are managing high blood pressure as well. But after more than a decade in this industry, we need to question why the economics of a monitoring program can have so much influence over which chronic conditions receive attention.
We already have the devices connected. We have established insurance benefits for diabetes testing supplies. And we have ways to measure whether patients are improving. What we have not fully worked out is how to bring those pieces together into a sustainable model that encourages longer-term diabetes management.
Diabetes should not receive less attention simply because it is more expensive to manage. That is exactly why it deserves more.
Tenovi helps healthcare organizations simplify remote patient monitoring through cellular-connected medical devices, reliable data transmission, and scalable device infrastructure. Book some time to talk to us today.
