Primary care quality and cost for privately insured patients in and out of US Health Systems: Evidence from four states

Abstract

Objective: To characterize physician health system membership in four states between 2012 and 2016 and to compare primary care quality and cost between insystem providers and non-system providers for the commercially insured population. Data Sources: Physician membership in health systems was obtained from a unique longitudinal database on health systems and matched at the provider level to 2014 all-payer claims data from Colorado, Massachusetts, Oregon, and Utah. Study Design: Using an observational study design, we compared physicians in health systems to non-system physicians located in the same state and geography on average cost of care (risk-adjusted using the Johns Hopkins' Adjusted Clinical Grouper), five HEDIS quality measures, one measure of developmental screening, and two Prevention Quality Indicator Measures. Data Collection/Extraction Methods: Patients in commercial health plans were attributed to a primary care physician accounting for the plurality of office visits. A cohort for each quality measure was constructed based on appropriate measure specifications.

The promise and peril of health systems

“…Riskadjusted total cost of care, for patients attributed to physicians in a system, is a commonly used measure. 5,8,9 However, with the notable exception in this volume of analysis of data from four states with All Payer Claims Data bases, most of the research analyzing total cost of care is limited to analysis of Medicare beneficiaries. 9 To the extent that we are concerned that large health systems are able to increase prices, analysis of data on privately insured patients is needed.…”

“…5,8,9 However, with the notable exception in this volume of analysis of data from four states with All Payer Claims Data bases, most of the research analyzing total cost of care is limited to analysis of Medicare beneficiaries. 9 To the extent that we are concerned that large health systems are able to increase prices, analysis of data on privately insured patients is needed. A health system that is able to improve quality and outcomes, to the extent that it is noticed by patients, may gain more patients, but it is difficult for patients to notice.…”

“…Development of valid and reliable measures of health system performance has been more challenging, reflecting the challenges of measuring performance in health care more generally. Risk‐adjusted total cost of care, for patients attributed to physicians in a system, is a commonly used measure 5,8,9 . However, with the notable exception in this volume of analysis of data from four states with All Payer Claims Data bases, most of the research analyzing total cost of care is limited to analysis of Medicare beneficiaries 9 .…”

Making integration work

“…Despite glimmers of hope, integration is not yielding significant improvements in documentable quality and cost of care. 2 Only one of the papers addresses equity of care, finding no dramatic effects. 3 None address effects on institutional racism.…”

“…The early returns from this research, however, suggest that on the ground, practice is not conforming to theory. Despite glimmers of hope, integration is not yielding significant improvements in documentable quality and cost of care 2 . Only one of the papers addresses equity of care, finding no dramatic effects 3 .…”