Journal of General Internal Medicine

, Volume 29, Issue 11, pp 1499–1505

Provider Collaboration: Cohesion, Constellations, and Shared Patients

  • Kenneth D. Mandl
  • Karen L. Olson
  • Daniel Mines
  • Chunfu Liu
  • Fang Tian
Original Research

DOI: 10.1007/s11606-014-2964-0

Cite this article as:
Mandl, K.D., Olson, K.L., Mines, D. et al. J GEN INTERN MED (2014) 29: 1499. doi:10.1007/s11606-014-2964-0



There is a natural assumption that quality and efficiency are optimized when providers consistently work together and share patients. Diversity in composition and recurrence of groups that provide face-to-face care to the same patients has not previously been studied.


Claims data enable identification of the constellation of providers caring for a single patient. To indirectly measure teamwork and provider collaboration, we measure recurrence of provider constellations and cohesion among providers.


Retrospective analysis of commercial healthcare claims from a single insurer.


Patients with claims for office visits and their outpatient providers. To maximize capture of provider panels, the cohort was drawn from the four regions with the highest plan coverage. Regional outpatient provider networks were constructed with providers as nodes and number of shared patients as links.

Main Measures

Measures of cohesion and stability of provider constellations derived from the networks of providers to quantify patient sharing.


For 10,325 providers and their 521,145 patients, there were 2,641,933 collaborative provider pairs sharing at least one patient. Fifty-four percent only shared a single patient, and 19 % shared two. Of 15,449,835 unique collaborative triads, 92 % shared one patient, 5 % shared two, and 0.2 % shared ten or more. Patient constellations had a median of four providers. Any precise constellation recurred rarely—89 % with exactly two providers shared just one patient and only 4 % shared over two; 97 % of constellations with exactly three providers shared just one patient. Four percent of constellations with 2+ providers were not at all cohesive, sharing only the hub patient. In the remaining constellations, a median of 93 % of provider pairs shared at least one additional patient beyond the hub patient.


Stunning variability in the constellations of providers caring for patients may challenge underlying assumptions about the current state of teamwork in healthcare.


accountable care organizationspatient care teamphysician’s practice patterns

Supplementary material

11606_2014_2964_MOESM1_ESM.docx (20 kb)
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Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Kenneth D. Mandl
    • 1
    • 2
  • Karen L. Olson
    • 1
    • 3
  • Daniel Mines
    • 4
  • Chunfu Liu
    • 4
  • Fang Tian
    • 4
  1. 1.Boston Children’s Hospital Informatics ProgramBostonUSA
  2. 2.Center for Biomedical InformaticsHarvard Medical SchoolBostonUSA
  3. 3.Department of PediatricsHarvard Medical SchoolBostonUSA
  4. 4.HealthCore, Inc.AlexandriaUSA