CHICAGO (January 25, 2022) –In its first report as a certified Medicare Qualified Entity (QE), Blue Health Intelligence® (BHI®) examines the relationships among preventable diabetes, hypertension admission rates and socioeconomic status (SES) measures to deliver preventive care to reduce avoidable hospitalization. The report’s findings reinforce the profound impact that social determinants of health (SDOH), including SES, have on health outcomes.

“This assessment underscores distinct relationships between observed admission rates and the SDOH factors of diabetics living in vulnerable and underserved populations,” said Michele Mercer, BHI’sAssociate Vice President for Analytic Consulting and Data Science. “Their hospitalizations and health outcomes are influenced by gender, poverty level, and other factors.”

The prevalence of diabetes has significantly increased over the last 20 years, resulting in an estimated 10.5% of the U.S. population being diagnosed with the disease as of 2020[1]. BHI found diabetes is a relevant topic of study due to its high prevalence and ability to be effectively managed if diagnosed early and treated appropriately.

BHI’s report analyzes five of the diabetes-related Agency for Healthcare Research and Quality’s Prevention Quality Indicators (PQIs) in relation to various SDOH and demographic factors, such as payer type, age, sex, and SES Index. Findings include:

  • Short-term diabetes complications (ketoacidosis, hyperosmolarity, or coma) showed the greatest observed hospital admission rates for people between the ages of 18 and 64 as compared to those 65 and older.
  • Observed admission rates were greater for those with a payer type of Medicare than those with a commercial payer across all PQIs studied.
  • Females demonstrated greater observed hypertension admission rates than males. However, males showed greater admission rates for all other diabetes-related complications.
  • Across all measures, lower SES was associated with higher rates of potentially avoidable diabetes-related hospitalizations, which further emphasizes the pronounced relationship between SDOH and healthcare outcomes.

BHI is among a few organizations that the Centers for Medicare & Medicaid Services (CMS) certified as a QE. The program requires assessments of national quality of care measures to be reported publicly. For this report, CMS granted BHI access to its Medicare fee-for-service claims data, which BHI combined with its national commercial data set for analysis.“
By combining CMS’ Medicare data with BHI’s national commercial data set, we can generate new insights into ways the healthcare industry can improve care quality, reduce costs, and promote transparency,” said Brian Lang, Senior Director of Analytic Consulting at BHI.


About Blue Health Intelligence

Leveraging the power of claims data from millions of Americans, Blue Health Intelligence® (BHI®) delivers insights that empower healthcare organizations to improve patient care, reduce costs, and optimize performance. With the most robust, up-to-date, and uniform data set in healthcare, BHI provides an accurate representation of the health profile of commercially insured Americans. BHI is the trade name of Health Intelligence Company LLC, an independent licensee of the Blue Cross Blue Shield Association. For more information, visit

For QE or media-related inquiries, contact us.

[1] Centers for Disease Control and Prevention (CDC). (2020). National Diabetes Statistics Report, 2020. Atlanta, GA: CDC.