Dupenloup Paul, Guan Grace, Aleppo Grazia, Bergenstal Richard M, Hood Korey, Kruger Davida, McArthur Teresa, Olson Beth, Oser Sean, Oser Tamara, Weinstock Ruth S, Gal Robin L, Kollman Craig, Scheinker David
Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
J Diabetes Sci Technol. 2025 May 13:19322968251340664. doi: 10.1177/19322968251340664.
The Virtual Diabetes Specialty Clinic (VDiSC) study demonstrated the feasibility of providing comprehensive diabetes care entirely virtually by combining virtual visits with continuous glucose monitoring support and remote patient monitoring (RPM). However, the financial sustainability of this model remains uncertain.
We developed a financial model to estimate the variable costs and revenues of virtual diabetes care, using visit data from the 234 VDiSC participants with type 1 or type 2 diabetes. Data included virtual visits with certified diabetes care and education specialists (CDCES), endocrinologists, and behavioral health services (BHS). The model estimated care utilization, variable costs, reimbursement revenue, gross profit, and gross profit margin per member, per month (PMPM) for privately insured, publicly insured, and overall clinic populations (75% privately insured). We performed two-way sensitivity analyses on key parameters.
Gross profit and gross profit margin PMPM (95% confidence interval) were estimated at $-4 ($-14.00 to $5.68) and -4% (-3% to -6%) for publicly insured patients; $267.26 ($256.59-$277.93) and 73% (58%-88%) for privately insured patients; and $199.41 ($58.43-$340.39) and 67% (32%-102%) for the overall clinic. Profits were primarily driven by CDCES visits and RPM. Results were sensitive to insurance mix, cost-to-charge ratio, and commercial-to-Medicare price ratio.
Virtual diabetes care can be financially viable, although profitability relies on privately insured patients. The analysis excluded fixed costs of clinic infrastructure, and securing reimbursement may be challenging in practice. The financial model is adaptable to various care settings and can serve as a planning tool for virtual diabetes clinics.
虚拟糖尿病专科诊所（VDiSC）研究表明，通过将虚拟就诊与持续血糖监测支持及远程患者监测（RPM）相结合，完全以虚拟方式提供全面糖尿病护理是可行的。然而，该模式的财务可持续性仍不确定。
我们开发了一个财务模型，以估算虚拟糖尿病护理的可变成本和收入，使用来自234名1型或2型糖尿病VDiSC参与者的就诊数据。数据包括与认证糖尿病护理和教育专家（CDCES）、内分泌学家及行为健康服务（BHS）的虚拟就诊。该模型估算了私人保险、公共保险及整个诊所人群（75%为私人保险）的护理利用率、可变成本、报销收入、毛利润及每人每月（PMPM）的毛利率。我们对关键参数进行了双向敏感性分析。
公共保险患者的PMPM毛利润和毛利率（95%置信区间）估计为-4美元（-14.00美元至5.68美元）和-4%（-3%至-6%）；私人保险患者为267.26美元（256.59美元至277.93美元）和73%（58%至88%）；整个诊所为199.41美元（58.43美元至340.39美元）和67%（32%至102%）。利润主要由CDCES就诊和RPM驱动。结果对保险组合、成本收费比及商业保险与医疗保险价格比敏感。
虚拟糖尿病护理在财务上可能可行，尽管盈利能力依赖于私人保险患者。该分析排除了诊所基础设施的固定成本，且在实践中确保报销可能具有挑战性。该财务模型可适应各种护理环境，并可作为虚拟糖尿病诊所的规划工具。
