Patient Sharing Among Physicians and Costs of Care: A Network Analytic Approach to Care Coordination Using Claims Data
- First Online:
Improving care coordination is a national priority and a key focus of health care reforms. However, its measurement and ultimate achievement is challenging.
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.
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
Costs of care, rates of hospitalizations
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.
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.
KEY WORDScare coordination performance measure provider social networks care density
- 1.Institute of Medicine. Priority Areas for National Action: Transforming Health Care Quality. Washington, DC: National Academies Press; 2003.Google Scholar
- 2.National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America's Healthcare. Washington, DC: National Quality Forum; 2008: http://www.nationalprioritiespartnership.org/uploadedFiles/NPP/08-253-NQF%20ReportLo%5B6%5D.pdf.
- 3.Report to Congress. National Strategy for Quality Improvement in Health Care. Washington, DC: U.S. Department of Health and Human Services; 2011.Google Scholar
- 8.National Quality Forum, NQF-Endorsed Definition and Framework for Measuring Care Coordination, http://www.qualityforum.org/projects/care_coordination.aspx, Accessed April 24, 2012.
- 9.McDonald K, Schultz E, Albin L, et al. Care Coordination Measures Atlas. Vol No. 11-0023-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2011: http://www.ahrq.gov/qual/careatlas/. Accessed April 24, 2012.
- 15.Wasserman S, Faust K. Social Network Analysis: Methods and Applications. New York: Cambridge University Press; 1999.Google Scholar
- 17.2010 National Healthcare Quality Report. 2010; http://www.ahrq.gov/qual/qrdr10.htm. Accessed April 24, 2012.
- 18.The Johns Hopkins ACG System Reference Manual Version 9.0. 2009; www.acg.jhsph.org. Accessed April 24, 2012.
- 19.Csardi G, Nepusz T. The igraph software package for complex network research. Paper presented at: International Conference on Complex Systems 2006; Boston, MA.Google Scholar
- 30.Liebhaber A, Grossman JM. Physicians Moving to Mid-Sized, Single-Specialty Practices. Tracking Report No.18. 2007. http://www.hschange.com/CONTENT/941/941.pdf. Accessed April 24, 2012.