Patient Sharing Among Physicians and Costs of Care

BACKGROUND: Improving care coordination is a national priority and a key focus of health care reforms. However, its measurement and ultimate achievement is challenging. OBJECTIVE: 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. DESIGN: Cohort study. PARTICIPANTS: 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. MAIN MEASURES: Costs of care, rates of hospitalizations. KEY RESULTS: 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. CONCLUSION: 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.