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Physician Membership in Health Systems Linked With Higher Patient Costs

November 08, 2020

Commercially insured patients had higher average costs from primary care physicians who were members of health systems compared with primary care physicians not in health systems, according to findings published online in the journal Health Services Research. 

“A growing share of physicians is part of a health system from 2012 to 2016,” researchers wrote. “Providers in health systems are not delivering primary care more efficiently than non-system providers for the commercially insured.”

The study focused on four states: Colorado, Massachusetts, Oregon, and Utah. Researchers were interested in the state of primary care physician health system membership between 2012 and 2016, and whether there was a difference in quality and costs between in-system providers and non-system providers for a commercially insured population. 

During the 5-year period, the share of physicians in health systems grew steadily. In 2016, 48% of primary care of physicians in Colorado and 63% in Utah were in-system providers, the study found.  

Performance on most Healthcare Effectiveness Data and Information Set (HEDIS) quality metrics analyzed was similar between in-system and non-system providers. However, rates of ambulatory care sensitive admissions were about 40% higher with in-system physicians. 

Meanwhile, in-system physicians were associated with $29 higher average costs per month than non-system physicians for commercially insured patients, according to the study.

Jolynn Tumolo 


Zhou RA, Beaulieu ND, Cutler D. Primary care quality and cost for privately insured patients in and out of US Health Systems: Evidence from four states [published online ahead of print, 2020 Oct 29]. Health Serv Res. 2020;10.1111/1475-6773.13590. doi:10.1111/1475-6773.13590

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