Doctors’ affiliations with large health systems may drive up costs

September 8, 2023—When primary care physicians (PCPs) work for or are affiliated with large health systems, their steering of patients toward specialists or other providers within those systems may be driving up health care costs, according to a new study led by researchers at Harvard T.H. Chan School of Public Health.

The study was published on September 1 in JAMA Health Forum. Co-authors included members of the Department of Health Policy and Management: Meredith Rosenthal, professor of health economics and policy; Mark Soto, research project and data assistant; and Anna Sinaiko and Vilsa Curto, both assistant professors of health economics and policy.

The researchers examined health utilization patterns among 4 million patients in Massachusetts from 2013 to 2017. They found that PCP affiliations with health systems—so called vertical relationships—were linked with more specialist visits, increased spending per-patient year, and increased spending on specialist visits, emergency visits, and hospitalizations within those health systems. For example, the study found that, after a PCP entered into a vertical relationship with a health system, specialist visits per patient-year increased by nearly 23% compared with a control group, and total medical expenditures per patient-year jumped by 6.26%.

While the authors acknowledged the potential benefits of vertical relationships, including improved coordination of care, they expressed concern that when PCPs associated with large health systems steer patients toward providers and services within their systems, it can drive up costs. “Policymakers, regulators, and purchasers may need to consider adopting a portfolio of countermeasures to limit the adverse implications of vertical relationships for the total cost of care,” they wrote.

Read the study: Utilization, Steering, and Spending in Vertical Relationships Between Physicians and Health Systems

Read coverage of the study in Axios: Primary care docs affiliated with health systems drove up spending: study

Read coverage of the study in RevCycleIntelligence: As PCPs Integrate With Health Systems, Steering Increases Costs