ArticleHealth services research2020
Organizational integration, practice capabilities, and outcomes in clinically complex medicare beneficiaries.
Article in Health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 30 citations in OpenAlex.
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- Ten Healthcare Delivery Trends and Their Measurement and Methodological Implications for Cancer Health Services Research.Health services research · 2026Article
- Higher intensity care for patients with multiple chronic conditions after hospital-physician integration.Health affairs scholar · 2026Article
- Health System Affiliation and Care for Dual-Eligible and Non-Dual-Eligible Medicare Beneficiaries.JAMA network open · 2025Article
- Government's 10 year plan for the NHS in England.BMJ (Clinical research ed.) · 2025Article
- Impact of hospital-physician integration on Medicare patient mix.The American journal of managed care · 2025Article
- Changes in US Primary Care Access and Capabilities During the COVID-19 Pandemic.JAMA health forum · 2025Article
- Better Together? A Mediation Analysis of French General Practitioners' Performance in Multi Professional Group Practice.Health services insights · 2025Article
- Cancer Treatment Before and After Physician-Pharmacy Integration.JAMA network open · 2024Article
- Hospital outpatient department billing is a poor indicator of primary care practice integration with hospital systems.Health services research · 2024Article
- Does Physician-Hospital Vertical Integration Affect Hospital Output?Health services insights · 2024Article
- The effects of behavioral health integration in Medicaid managed care on access to mental health and primary care services-Evidence from early adopters.Health services research · 2023Article
- The Association of Readmission Reduction Activities with Primary Care Practice Readmission Rates.Journal of general internal medicine · 2022Article
- Association of Rurality, Race and Ethnicity, and Socioeconomic Status With the Surgical Management of Colon Cancer and Postoperative Outcomes Among Medicare Beneficiaries.JAMA network open · 2022Article
- Physician- versus practice-level primary care continuity and association with outcomes in Medicare beneficiaries.Health services research · 2022Article
- Physician Practices With Robust Capabilities Spend Less On Medicare Beneficiaries Than More Limited Practices.Health affairs (Project Hope) · 2022Article
- Article
- Low-Value Care at the Actionable Level of Individual Health Systems.JAMA internal medicine · 2021Article
Corrections and comments
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Authors and funding
8 authors at 5 institutions in 1 country.
Funding
Abstract
objectiveTo assess the association between clinical integration and financial integration, quality-focused care delivery processes, and beneficiary utilization and outcomes. DATA SOURCES: Multiphysician practices in the 2017-2018 National Survey of Healthcare Organizations and Systems (response rate 47%) and 2017 Medicare claims data. STUDY
designCross-sectional study of Medicare beneficiaries attributed to physician practices, focusing on two domains of integration: clinical (coordination of patient services, use of protocols, individual clinician measures, access to information) and financial (financial management and planning across operating units). We examined the association between integration domains, the adoption of quality-focused care delivery processes, beneficiary utilization and health-related outcomes, and price-adjusted spending using linear regression adjusting for practice and beneficiary characteristics, weighting to account for sampling and nonresponse. DATA COLLECTION/EXTRACTION
methods1 604 580 fee-for-service Medicare beneficiaries aged 66 or older attributed to 2113 practices. Of these, 414 209 beneficiaries were considered clinically complex (frailty or 2 + chronic conditions). PRINCIPAL
findingsFinancial integration and clinical integration were weakly correlated (correlation coefficient = 0.19). Clinical integration was associated with significantly greater adoption of quality-focused care delivery processes, while financial integration was associated with lower adoption of these processes. Integration was not generally associated with reduced utilization or better beneficiary-level health-related outcomes, but both clinical integration and financial integration were associated with lower spending in both the complex and noncomplex cohorts: (clinical complex cohort: -$2518, [95% CI: -3324, -1712]; clinical noncomplex cohort: -$255 [95% CI: -413, -97]; financial complex cohort: -$997 [95% CI: -$1320, -$679]; and financial noncomplex cohort: -$143 [95% CI: -210, -$76]).
conclusionsHigher levels of financial integration were not associated with improved care delivery or with better health-related beneficiary outcomes. Nonfinancial forms of integration deserve greater attention, as practices scoring high in clinical integration are more likely to adopt quality-focused care delivery processes and have greater associated reductions in spending in complex patients.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.