In fact, Dr. Frakt found evidence against integrated delivery systems is so strong he wrote, “The lesson is simple: Coordinating your own care is still a good idea. Don’t count on the health system to do it for you.” In coming to this conclusion Dr. Frakt cited a host of studies that found integrated delivery systems — like Rochester, Minn.-based Mayo Clinic or Danville, Pa.-based Geisinger Health System, for example — did not provide meaningfully better quality of care, and often did it at a higher cost. Other studies found minor improvements in quality, such as increased screenings, but still found higher costs were associated to larger healthcare networks or hospital-owned physician practices.
Studies of ACOs cited by Dr. Frakt indicated ACOs do not reduce costs once bonus payments are factored in — except for ACOs led by independent primary care physicians. This fact — that bigger isn’t always better in healthcare — is an idea that dates back to 1966, according to Dr. Frakt.
He said this idea comes from Avedis Donabedian, MD, a researcher from Ann Arbor-based University of Michigan, who found that the way healthcare delivery is organized has little correlation to patient outcomes.
“As anyone who has worked in a large company or has managed a large group knows, the more people involved, the harder it is to coordinate activities,” Dr. Frakt wrote.
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