Concentration and Segregation of Care in Health Systems

The organization of health care delivery in the United States has gone through some important changes in recent years, with health systems playing an increasingly important role. However, much remains unknown about how this new health care landscape affects cost, quality, and access to care, especially how such effects differ for patients with different insurance coverage. Using APCD data from different states, we first characterize the organizational landscape of health care providers in these states and the provider choice patterns of Medicaid and Commercial-insured patients, with a focus on the utilization of physician services. We ask whether Medicaid patients and commercial-insured patients seek care from the same providers, different providers within the same system, or different providers in different systems. We then use these patterns to quantify the extent of concentration and segregation of care for patients on different types of insurance (Medicaid vs. commercial). Next, we explore how such concentration and segregation relates to quality. Specially, we examine whether providers who treat a high number/share of Medicaid patients perform better on quality metrics that are more prevalent among Medicaid patients, such as effective care management for patients with complex chronic conditions.