Physician groups more bullish on shifting care to lower-cost settings than hospitals

More than half of physician organizations surveyed about marketplace opportunities to improve quality and efficiency use incentives to shift care to lower-cost settings. But only one-third of hospitals and about one-fourth of health system respondents said they were doing so.

That's just one of the findings of the NEJM Catalyst Insights Council report summarized by the publication. It was an indication of the degree to which physician organizations and hospital or healthcare delivery systems define "low-hanging fruit" differently, according to the article.

The three groups used high-risk care coordinators to the same degree--about 70 percent said they use the coordinators--but larger organizations based on patient revenue were more likely to use high-risk care coordinators and incentives to keep care within the system.

High-risk care coordinators have been shown to reduce care costs for insured patients with chronic conditions: One study showed average monthly cost of care  fell 21 percent for the highest-risk patients, FierceHealthFinance previously reported.

One independent community hospital in Illinois used 60 newly trained clinical care coordinators as part of a new patient flow model that reduced lengths of stay and kept patients better informed of the procedures, testing and other events scheduled each day.

The survey of 297 healthcare leaders also found that health systems were more likely to put groups of doctors at risk for total medical expenditures for populations of patients, known as capitation--42 percent reported doing so, versus 21 percent of hospital and physician organizations. Researchers said that could be because hospitals and physician groups didn't have the skills or infrastructure to employ risk-sharing.

The South reported significantly lower rates of capitation than the Northeast or the Northwest, according to the article, possibly because there are more for-profit entities.

Across the board, there was no evidence that larger organizations were likely to do more to improve quality and efficiency, according to the article. In addition, there was evidence that some initiatives such as same-day appointments could be harder to implement in bigger, more complex organizations.

The findings suggested that "different parts of the healthcare system respond to different incentives, and leaders probably need to tailor thinking about competition and pressure for improvement for different settings," the researchers concluded.

To learn more:
- read the NEJM Catalyst article