OBJECTIVES: • Build economic model to estimate resources to deliver current standards of care to US diabetes patients • Evaluate provider costs to meet standards, assess patient outcomes specified in guidelines relative to reimbursement METHODS: • Build model • Integrate 3 national standard sets (ADA, AACE, and TES) into 28 consolidated standards of optimal care  • Develop provider matrix for rendering care • Draft 6 clinical vignettes: 3 each T1DM and T2DM • Convene 3 multidisciplinary panels of 4-7 care professionals; with facilitator, estimate minimum/maximum time to achieve care standards/patient type – baseline/best cases • Convene separate panel estimating time to start/follow patients using CSII or CGM • Multiply provider time by average wage and overhead amounts to determine visit cost • Map activities to CPT and HCPCS billing codes and payment rates • Compute reimbursement per expected payer mix • Note gaps in reimbursement compared to costs on unit and total basis • Populate model; perform analytics • Repeat Steps 4-9 with data from national  provider survey and national database RESULTS: • Baseline scenarios show provider costs exceed reimbursements for all type patients; best case indicates same in 5 of 6 scenarios • In different scenarios costs of treating adults exceed reimbursement by >$750,000 per year; practices would require 19%-64% increase to breakeven • In pediatric practice, costs exceed reimbursement by >$471,000 per year • Gaps are increased for patients using CSII and CGM • Results are more sensitive to reimbursement for routine physician care and lifestyle modification services CONCLUSIONS: • 7 American professional societies comprising the Diabetes Working Group (DWG) concur delivering high-quality, guideline-based diabetes care unrealistic given current care and payment paradigms • DWG recommends alternative approaches in 3 areas: care management, payment reform, and workforce supply, to mitigate increasing medical and financial impact of this epidemic chronic illness • Model can be used internationally to support public policy efforts