For Immediate Release: February 25, 2015
Contact: Jill Braunstein at (202) 243-7009
WASHINGTON, D.C.—Based on publicly available information, there is scant evidence to back up claims by large, nonprofit integrated health systems that they deliver higher quality care more efficiently, according to a new study released today from the nonpartisan National Academy of Social Insurance (NASI). The report will be discussed at a 2pm panel on trends in provider consolidation during a Federal Trade Commission / Department of Justice live webcasted workshop on “Examining Health Care Competition.”
Along with a comprehensive review of the academic literature, the study included an analysis of publicly available quality and financial information from 15 of the largest nonprofit integrated delivery networks (IDNs) across the country, including Henry Ford Health System in Detroit; North Shore-LIJ Health System in suburban New York; Intermountain Healthcare in Utah/Idaho; Sutter Health in Northern California; BayCare Health System in Tampa/St. Petersburg; and Geisinger Health System in Central Pennsylvania.
The study defined IDNs as vertically integrated health services networks that include hospitals, physicians, post-acute services and sometimes health plans with a stated purpose to coordinate care across the continuum of health services and to manage population health; or fully integrated provider systems inside a health plan (e.g. with no other source of income than premiums).
"Some of the nation’s finest hospitals and clinical staffs can be found in this fifteen IDN sample. This analysis was not intended to denigrate these fine institutions or their managements," said Jeff Goldsmith, the study’s lead author, President of Health Futures, Inc., and Associate Professor of Public Health Sciences at the University of Virginia. "Rather, it is intended to address whether the way they have organized care creates measureable benefits to society, or for that matter, to the institutions themselves. If these benefits exist, we could not find evidence of them in their public disclosures, beyond the claimed ‘community benefit’ common to all non-profits."
According to the study, IDNs have "operated under a halo of presumed societal benefits (quality, efficiency, care integration, etc.) for the better part of four decades with remarkably little evidence that these benefits in fact exist. It is still possible that these societal benefits of IDNs exist. But if they do, given the opacity of present IDN disclosure of key operating information, they eluded us in this preliminary investigation. If public policy is to continue fostering IDN growth and development, a more solid evidentiary foundation for this form of medical care organization seems essential. The mere presumption of societal benefits of IDN formation or operations is no longer tenable as a policy principle."
Commissioned by the Academy’s Study Panel on Pricing Power in Healthcare Markets, the findings are detailed in the new report—Integrated Delivery Networks: In Search of Benefits and Market Effects—written by Goldsmith along with Lawton R. Burns, the James Joo-Jin Kim Professor of Health Care Management at the University of Pennsylvania’s Wharton School, Aditi Sen, a doctoral student at the Wharton School and Trevor Goldsmith, Researcher Director of Health Futures, Inc. The Academy’s study panel will release its final report next month.
Other key study findings include:
The study’s policy recommendations include:
The National Academy of Social Insurance is a non-profit, nonpartisan organization made up of the nation’s leading experts on social insurance. Its mission is to advance solutions to challenges facing the nation by increasing public understanding of how social insurance contributes to economic security.