The organization of a health care delivery system can have significant impacts on the quality and costs of care patients receive. Efforts to transform and improve these systems progress, but more evidence is needed to better understand these changes and their impacts. The new issue of Health Services Research explores the current state of health systems and the impact of different system characteristics on quality, cost, and equity. This research was supported by the Agency for Healthcare Research and Quality’s Comparative Health System Performance Initiative.
In this issue, the article by Mathematica researchers Rachel Machta, David Jones, Laura Kimmey, and Eugene Rich, James Reschovsky from JR Health Policy Consultants, LLC, and Michael Furukawa from the Agency for Healthcare Research and Quality examined health system integration with physician specialties across markets. Using data from the agency’s Compendium of U.S. Health Care Systems, the authors found that, in recent years, a growing number of primary care and selected specialties have been participating in vertically integrated systems in which a group of affiliated doctors, hospitals, and others organize under one managing entity.
Though rates of integration varied substantially across markets, in 2018, the physicians that most often participated in an integrated health system were those in specialties that were more likely to contribute to hospital revenue through the referral of lucrative hospital services. On the other hand, systems that serve distinct missions such as academic medical centers and publicly owned health systems were more likely to affiliate with specialties unrelated to the physicians’ potential contribution to hospital revenue. These findings reveal that the motivations for integration must be considered in future payment policies so they provide incentives to systems to integrate with physician specialties in a way that promotes higher-value care.
In addition to the 10 articles sharing new insights about health systems and their performance, the issue features commentaries by David Blumenthal, M.D., M.P.P., president of the Commonwealth Fund and former National Coordinator for Health Information Technology, and Richard Kronick, professor in the Herbert Wertheim School of Public Health at the University of California, San Diego and former director of the Agency for Healthcare Research and Quality. Blumenthal writes that changes to payment models that incentivize quality and value are necessary before health system leaders are likely to make lasting, meaningful changes to frontline care processes. Kronick agreed that payment models must move away from fee-based reimbursement toward population-based reimbursement, and he argues that although the emergence of integrated health systems may improve health care delivery, the benefits are unlikely to be realized without good policy and regulatory oversight.
Explore more findings here about health systems from Mathematica’s work as the Coordinating Center for the Comparative Health System Performance Initiative.