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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 3 of 3 Research Studies DisplayedGraves JA, Nshuti L, Everson J
Breadth and exclusivity of hospital and physician networks in US insurance markets.
The goal of this study was to quantify network breadth and overlap among primary care physician (PCP), cardiology, and general acute care hospital networks for employer-based (large group and small group), individually purchased (marketplace), Medicare Advantage (MA), and Medicaid managed care (MMC) plans. The main outcomes measured were percentage of in-network physicians and/or hospitals within a 60-minute drive from a hypothetical patient in a given zip code (breadth), and the number of physicians and/or hospitals within each network that overlapped with other insurers' networks, expressed as a percentage of the total possible number of shared connections (exclusivity). Networks were categorized by network breadth size and analyzed by insurance type, state, and insurance, physician, and/or hospital market concentration level, as measured by the Hirschman-Herfindahl index. Markets with concentrated primary care and insurance markets had the broadest and least exclusive primary care networks among large-group commercial plans. Markets with the least concentration had the narrowest and most exclusive networks. Rising levels of insurer and market concentration were associated with broader and less exclusive healthcare networks. The authors suggest that this means that patients could switch to a lower-cost, narrow network plan without losing-in-network coverage to their PCP.
AHRQ-funded; HS025976; HS026395.
Citation: Graves JA, Nshuti L, Everson J .
Breadth and exclusivity of hospital and physician networks in US insurance markets.
JAMA Netw Open 2020 Dec;3(12):e2029419. doi: 10.1001/jamanetworkopen.2020.29419..
Keywords: Health Insurance, Learning Health Systems, Health Systems, Primary Care, Hospitals, Healthcare Delivery
Machta RM, Reschovsky JD, Jones DJ
AHRQ Author: Furukawa MF
Health system integration with physician specialties varies across markets and system types.
Data from the AHRQ Compendium of US Health Systems and the IQVIA OneKey database was used to examine the change from 2016 to 2018 in the percentage of physicians in systems, focusing on primary care and the 10 most numerous non-hospital based specialties across 382 metropolitan statistical areas (MSAs) in the US. The authors also categorized systems by ownership, mission, and payment program participation and examined how these characteristics were related to their patterns of physician integration in 2018. Findings were that specialists with lucrative hospital services were the most commonly integrated with systems, including hematology-oncology, cardiology, and general surgery. High market concentration by insurers and hospital-systems was associated with lower rates of physician integration. In addition, systems with academic medical centers (AMCs) and publicly owned systems unrelated to the physicians’ potential contribution to hospital revenue, and investor-owned systems demonstrated more limited physician integration.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Machta RM, Reschovsky JD, Jones DJ .
Health system integration with physician specialties varies across markets and system types.
Health Serv Res 2020 Dec;55(Suppl 3):1062-72. doi: 10.1111/1475-6773.13584..
Keywords: Health Systems, Healthcare Delivery, Primary Care
Harvey JB, Vanderbrink J, Mahmud Y
Understanding how health systems facilitate primary care redesign.
The objectives of this study were to understand how health systems are facilitating primary care redesign (PCR), examine the PCR initiatives taking place within systems, and identify barriers to this work. A sample of 24 health systems in 4 states was used to identify how system leaders define and implement initiatives to redesign primary care delivery and identify challenges. Codes based on the theoretical PCR literature was used and researchers also created new codes. Semi-structured telephone interviews with 162 system executives and physician organization leaders from 24 systems were conducted. Initiatives to redesign the delivery of primary care were described by leaders, but many were still in the early stages. Motivating factors for team-based care included improvement efficiency and enhancing clinician job satisfaction. Changes in payment and risk assumption as well as community needs were commonly cited as motivators for population health management and care coordination. Challenges health systems face in redesigning primary included return on investment and slower than anticipated rate in moving from fee-for-service to value-based payment.
AHRQ-funded; HS024067.
Citation: Harvey JB, Vanderbrink J, Mahmud Y .
Understanding how health systems facilitate primary care redesign.
Health Serv Res 2020 Dec;55(Suppl 3):1144-54. doi: 10.1111/1475-6773.13576..
Keywords: Health Systems, Primary Care: Models of Care, Primary Care, Healthcare Delivery