Med Care

BackgroundThe Centers for Medicare & Medicaid Services (CMS) State Innovation Models (SIM) Initiative funds states to accelerate delivery system and payment reforms. All SIM states focus on improving diabetes care, but SIM\u2019s effect on 30-day readmissions among adults with diabetes remains unclear.MethodsA quasi-experimental research design estimated the impact of SIM on 30-day hospital readmissions among adults with diabetes in three Round 1 SIM states (N=671,996) and three comparison states (N=2,719,603) from 2010\u20132015. Difference-in-differences (DID) multivariable logistic regression models that incorporated four-group propensity score weighting were estimated. Heterogeneity of SIM effects by grantee state and for CMS populations were assessed.ResultsIn adjusted DID analyses, SIM was associated with an increase in odds of 30-day hospital readmission among patients in SIM states in the post- versus pre-SIM period relative to the ratio in odds of readmission among patients in the comparison states post- versus pre-SIM (ratio of aOR=1.057, p=0.01). Restricting the analyses to CMS populations (Medicare and Medicaid beneficiaries), resulted in consistent findings (ratio of aOR= 1.057, p=0.034). SIM did not have different effects on 30-day readmissions by state.ConclusionsWe found no evidence that SIM reduced 30-day readmission rates among adults with diabetes during the first 2 years of Round 1 implementation, even among CMS beneficiaries. It may be difficult to reduce readmissions statewide without greater investment in health information exchange and more intensive use of payment models that promote interorganizational coordination.U18 DP006123/DP/NCCDPHP CDC HHS/United States2020-06-29T00:00:00Z32412950PMC73242987915vault:3566