New research highlights role and impact of integrated health systems in the U.S.

New findings published by Dartmouth researchers are featured in a special issue of Health Services Research--a top journal that reports on original investigations that enhance understanding of the healthcare field and help improve the health of individuals and communities.

The special issue focuses on new research highlighting the role and impact of integrated health systems in the U.S.--a type of organization that has grown dramatically in recent years and includes hospitals and outpatient physician practices.

In the paper, "Organizational Integration, Practice Capabilities, and Outcomes in Clinically Complex Medicare Beneficiaries," Carrie Colla, Ph.D., a professor of The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine, and colleagues assessed the association between clinical integration and financial integration, quality-focused care delivery processes, and beneficiary utilization and outcomes.

Physician practices have become increasingly financially integrated through ownership relationships in recent years. Health system leaders have argued this financial integration improves patient care through better clinical integration.

However, the results of the study show that financial integration and clinical integration were not well-correlated, while financial integration had few positive effects on health or spending indicators.

We found that within multi-physician practices, higher levels of financial integration were not associated with improved care delivery or better outcomes for Medicare patients. Greater clinical integration, however, was associated with greater use of quality-focused care delivery processes and less spending."

Carrie Colla, PhD, Professor of The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine

Clinical integration deserves greater attention, she says, as organizations with high clinical integration are more likely to adopt care processes to improve the experience and outcomes of patients.

Colla's paper is one of 10 peer-reviewed journal articles featured in the special issue that together examine health systems from multiple perspectives, including impacts on quality, costs, and care delivery.

While collectively the findings show that healthcare systems as they currently exist are not yet a cure for the problems that ail healthcare across the country, Colla's paper and the others', including recently published research by Dartmouth professor Elliott Fisher, are leading to new understandings about the prevalence, roles, and impacts of integrated health systems.

The U.S. Agency for Healthcare Research and Quality (AHRQ)--the lead federal agency responsible for improving the safety and quality of the U.S. healthcare system--supported this research by creating the Comparative Health System Performance (CHSP) initiative.

Dartmouth is one of three centers of excellence established by the CHSP that are tasked with taking different approaches to study the landscape, impact, and trends across health systems--including factors that impact the use of evidence-based practices in care delivery.

The Dartmouth Institute for Health Policy and Clinical Practice is a world leader in studying and advancing models for disruptive change in healthcare delivery.

The work of Dartmouth Institute faculty and researchers includes developing the concept of shared decision-making between patients and healthcare professionals, creating the model for Accountable Care Organizations (ACOs), and introducing the game-changing concept that more healthcare is not necessarily better care.