Integrated and quality-based physician practice: its long term impact on their patients' health care utilization

Summary Aim: The fragmentation of the care delivery system and the lack of integration along the entire care delivery process can result in avoidable harm to patients as well as expensive inefficiencies and waste to the delivery system. Intermountain Healthcare (IH) Utah - USA has integrated ambulatory and hospital care via its clinical integration programs. After presenting the organizational components of these programs, this paper studies the impact on patient medical utilization and claims expenditure resulting from the degree of participation of the patient's primary provider(s) in the IH clinical integration programs. Methods: This study uses a retrospective quasi- experimental design to follow a cohort of patients and their primary provider(s) longitudinally over 7 years and identify their degree of participation in the IH system. The study group includes patients whose primary provider(s) fully participate in IH clinical integration programs continuously over the study period. The control group includes patients whose primary provider(s) do not participate continuously over the study period. Results: When the patients' primary physician(s) participate(s) continuously in IH programs, the patients have on average one fewer encounter a year and $326 or 246€ less in annual expenses. In addition, the rate of health care expenditure growth for these patients is 1% less a year. Conclusion: This study demonstrates differences in medical utilization and claim expenses based on differences in level of practice participation in IH clinical integration programs. Prat Organ Soins. 2012;43(4):251-259.