The Centers for Medicare and Medicaid Services State Innovation Models Initiative and social risk factors: Improved diagnosis among hospitalized adults with diabetes

Introduction: Unaddressed social risks among hospitalized patients with chronic conditions contribute to costly complications and preventable hospitalizations. This study examines whether the Centers for Medicaid and Medicare Services State Innovation Models initiative, through payment and delivery system reforms, accelerates the diagnosis of social risk factors among hospitalized adults with diabetes. Methods: Encounter-level data were from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases (2010–2015, N=5,040,456). Difference-in-difference logistic regression estimated the extent to which hospitalized adults with diabetes in 4 State Innovation Models states (Arkansas, Massachusetts, Oregon, and Vermont) had increased odds of having a social risk factor diagnosed with an ICD-9 V code compared with hospitalized adults with diabetes in 4 comparison states (Arizona, Georgia, New Jersey, and New Mexico) 2 years after implementation. Data were analyzed between June and December 2019. Results: Adults with diabetes who were hospitalized in State Innovation Models states had a 30% greater increase in the odds of having a V code documented after implementation than adults with diabetes who were hospitalized in comparison states (AOR=1.29, 95% CI=1.07, 1.56). However, V code use remained infrequent, with only 2.05% of encounters, on average, having any V codes on record in State Innovation Models states after implementation. Conclusions: The State Innovation Models initiative slightly but significantly improved the diagnosis of social risks among hospitalized adults with diabetes. State-led delivery system and payment reform may help support movement of hospitals toward better recognition and management of social determinants of health.