Integrated health systems, market concentration, and socioeconomic disparities in quality of care

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Project Summary/Abstract Americans at opposite ends of the socioeconomic spectrum differ in life expectancy by 10 to 15 years. Socioeconomic status (SES) and other social determinants of health (SDOH), such as employment, stable housing, and access to healthy food, explain much of these differences. However, numerous studies also show that low-income patients receive worse medical care than high-income patients across a wide range of quality measures. Many low-SES patients receive care from physician organizations (POs) that have fewer resources to care for patients with complex health and social needs, including multidisciplinary care teams and advanced health information technology, compared with POs serving higher-income patients. Meanwhile, integrated health systems, health care organizations that own both hospitals and POs, are expanding across the country with potentially far-reaching changes in how medical care is delivered. POs owned by health systems may be well-positioned to support initiatives that address SDOH through access to capital that could support infrastructure improvements, better access to specialty care for their patients, and better coordination across care settings. However, prior studies have shown that health system-ownership of POs has little to no effect on quality, is associated with higher spending, and may lead to worse patient experiences. It is not known whether POs that treat low SES patients are joining health systems or how health system ownership affects care for low SES patients. The specific aims of this study are to: (1) assess trends in health system ownership of POs that serve patients with low SES; (2) assess the impact of health system ownership of POs on SES disparities in access to care and quality of care; (3) decompose the effects of ownership changes on SES disparities into within-PO and between-PO effects; and (4) identify mechanisms through which health system-owned POs and independent POs achieve reductions in SES disparities. The proposed study builds on research conducted by the investigators as part of an AHRQ-funded Center of Excellence on Health System Performance that explored the impact of hospital ownership changes on quality of care, racial and ethnic differences in quality of care between heath system-owned POs and independent POs, and efforts to achieve clinical integration by safety net providers. The study will provide policymakers with timely information about the potential benefits or unintended consequences for vulnerable populations of PO ownership by health systems and the role of physician market concentration and other market characteristics in explaining trends in SES disparities. Primary data collection from 30 POs and their community partners will identify the specific strategies that POs are using to reduce SES disparities and to determine the value added of health system ownership.