Abstract
BACKGROUND
Improving care coordination is a national priority and a key focus of health care reforms. However, its measurement and ultimate achievement is challenging.
OBJECTIVE
To test whether patients whose providers frequently share patients with one another—what we term ‘care density’—tend to have lower costs of care and likelihood of hospitalization.
DESIGN
Cohort study
PARTICIPANTS
9,596 patients with congestive heart failure (CHF) and 52,688 with diabetes who received care during 2009. Patients were enrolled in five large, private insurance plans across the US covering employer-sponsored and Medicare Advantage enrollees
MAIN MEASURES
Costs of care, rates of hospitalizations
KEY RESULTS
The average total annual health care cost for patients with CHF was $29,456, and $14,921 for those with diabetes. In risk adjusted analyses, patients with the highest tertile of care density, indicating the highest level of overlap among a patient’s providers, had lower total costs compared to patients in the lowest tertile ($3,310 lower for CHF and $1,502 lower for diabetes, p < 0.001). Lower inpatient costs and rates of hospitalization were found for patients with CHF and diabetes with the highest care density. Additionally, lower outpatient costs and higher pharmacy costs were found for patients with diabetes with the highest care density.
CONCLUSION
Patients treated by sets of physicians who share high numbers of patients tend to have lower costs. Future work is necessary to validate care density as a tool to evaluate care coordination and track the performance of health care systems.
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Acknowledgments
Contributors
The authors thank Donniell Fishkind for his careful review of the manuscript. He did not receive compensation for his effort.
Funders
Dr. Pollack’s salary was supported by a career development award from the NIH National Cancer Institute and Office of Behavioral and Social Sciences Research (1K07CA151910-01A1). The funders had no role in the design and conduct off the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Conflict of Interest
This work was performed with support by faculty and staff at The Johns Hopkins University, where the ACG method was developed and is maintained. The Johns Hopkins University holds the copyright to the ACG software. To help support research and development, The Johns Hopkins University receives royalties from health plans and other organizations that use the ACG software. The authors declare that they do not have a conflict of interest.
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Pollack, C.E., Weissman, G.E., Lemke, K.W. et al. Patient Sharing Among Physicians and Costs of Care: A Network Analytic Approach to Care Coordination Using Claims Data. J GEN INTERN MED 28, 459–465 (2013). https://doi.org/10.1007/s11606-012-2104-7
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DOI: https://doi.org/10.1007/s11606-012-2104-7