Assessing the Financial Sustainability of a Virtual Clinic Providing Comprehensive Diabetes Care

Paul Dupenloup¹, Grace Guan¹, Grazia Aleppo², Richard M Bergenstal³, Korey Hood⁴, Davida Kruger⁵, Teresa McArthur⁶, Beth Olson⁷, Sean Oser⁸, Tamara Oser⁸, Ruth S Weinstock⁹, Robin L Gal¹⁰, Craig Kollman¹⁰, David Scheinker^{1

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Affiliations

¹ Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
² Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
³ International Diabetes Center, Minneapolis, MN, USA.
⁴ School of Medicine, Stanford University, Stanford, CA, USA.
⁵ Henry Ford Health System, Detroit, MI, USA.
⁶ Cecelia Health, New York, NY, USA.
⁷ Lagoon Health, Minneapolis, MN, USA.
⁸ School of Medicine, University of Colorado, Aurora, CO, USA.
⁹ SUNY Upstate Medical University, Syracuse, NY, USA.
¹⁰ Jaeb Center for Health Research, Tampa, FL, USA.
¹¹ Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, USA.
¹² Clinical Excellence Research Center, Stanford University, Stanford, CA, USA.
¹³ Department of Medicine, Division of Biomedical Informatics Research, Stanford University, Stanford, CA, USA.

PMID: 40357670
PMCID: PMC12075182
DOI: 10.1177/19322968251340664

Assessing the Financial Sustainability of a Virtual Clinic Providing Comprehensive Diabetes Care

Paul Dupenloup et al. J Diabetes Sci Technol. 2025.

. 2025 May 13:19322968251340664.

doi: 10.1177/19322968251340664. Online ahead of print.

Authors

Affiliations

¹ Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
² Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
³ International Diabetes Center, Minneapolis, MN, USA.
⁴ School of Medicine, Stanford University, Stanford, CA, USA.
⁵ Henry Ford Health System, Detroit, MI, USA.
⁶ Cecelia Health, New York, NY, USA.
⁷ Lagoon Health, Minneapolis, MN, USA.
⁸ School of Medicine, University of Colorado, Aurora, CO, USA.
⁹ SUNY Upstate Medical University, Syracuse, NY, USA.
¹⁰ Jaeb Center for Health Research, Tampa, FL, USA.
¹¹ Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, USA.
¹² Clinical Excellence Research Center, Stanford University, Stanford, CA, USA.
¹³ Department of Medicine, Division of Biomedical Informatics Research, Stanford University, Stanford, CA, USA.

PMID: 40357670
PMCID: PMC12075182
DOI: 10.1177/19322968251340664

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: continuous glucose monitoring; diabetes; health economics; remote patient monitoring; telemedicine.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: G.A. reported grants from The Leona M. and Harry B. Helmsley Charitable Trust during the conduct of the study and personal fees from Bayer, Dexcom, and Insulet; nonfinancial support from Eli Lilly; and grants from Dexcom, Eli Lilly, Fractyl Health, Emmes, Mannkind, Tandem Diabetes Care, and Welldoc outside the submitted work. R.M.B. reported grants from Abbott Diabetes Care, Eli Lilly, Hygieia, Dexcom, Sanofi, Tandem Diabetes Care, Insulet, and Medtronic and consulting and/or advisory board fees paid to his institution from Abbott Diabetes Care, Dexcom, Onduo, Sanofi, Roche, Embecta, and Medtronic during the conduct of the study. R.L.G. reported grants from The Leona M. and Harry B. Helmsley Charitable Trust during the conduct of the study. K.H. reported consulting fees from Sanofi, Havas Health, and MannKind; investigator-initiated grant from Embecta. C.K. reported grants from The Leona M. and Harry B. Helmsley Charitable Trust and nonfinancial support from Dexcom during the conduct of the study; grants from JDRF, Diasome, and MannKind outside the submitted work; and nonfinancial support from Tandem, Dexcom, and Insulet outside the submitted work. D.K. reported grants from Abbott and advisor and/or speaking fees from Abbott, Dexcom, and Jaeb Center for Health Research outside the submitted work. B.O. reported personal fees from Lagoon Health during the conduct of the study and stock ownership in Abbott Laboratories. S.O. reported grants from The Leona M. and Harry B. Helmsley Charitable Trust during the conduct of the study and consulting fees from Cecelia Health and advisory board fees from Dexcom outside the submitted work. T.O. reported grants from The Leona M. and Harry B. Helmsley Charitable Trust during the conduct of the study and consulting fees from Cecelia Health, advisory board fees from Dexcom, and an investigator-initiated grant from Abbott Diabetes Care outside the submitted work. R.S.W. reported personal fees from The Leona M. and Harry B. Helmsley Charitable Trust and Jaeb Center for Health Research during the conduct of the study; grants for participation in multicenter clinical trial through her institution from Eli Lilly, Novo Nordisk, Insulet, Tandem, Amgen, and MannKind outside the submitted work; and discounted devices for clinical research from DexCom outside the submitted work. D.S. has received support from Stanford MCHRI, Stanford HAI, the NSF, and the Helmsley Charitable Trust, and is an advisor to Carta Health. P.D. has received support from Stanford HAI and Stanford SIGF. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

**Figure 1.**
The average utilization of 30-minute certified diabetes care and education specialist (CDCES) visits (left) and 30-minute behavioral health services (BHS) visits (right) per month. The colors represent insurance types (public vs private).

**Figure 2.**
Two-way sensitivity analysis: expected gross profit margin of virtual clinic per member, per month, as a function of cost-to-charge ratio and commercial-to-Medicare price ratio.

See this image and copyright information in PMC

References

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Assessing the Financial Sustainability of a Virtual Clinic Providing Comprehensive Diabetes Care

Affiliations

Assessing the Financial Sustainability of a Virtual Clinic Providing Comprehensive Diabetes Care

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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