OTHER PROJECT INFORMATION – Project Summary/Abstract
PA-20-072: Are Health Systems Better at Responding to Pandemics?
The goal of this project is to provide evidence on whether integrated health systems lead to better or worse care
outcomes than independent providers during the COVID-19 epidemic. Health care has undergone enormous
consolidation in recent years, as providers have rapidly assembled into bigger systems. Practitioners and policy
makers have engaged in spirited debate about whether such consolidation is good or bad, but there has been
only a little empirical evidence on the topic.
We will study the impact of integrated care in a crucially important setting – the response to the COVID-19
epidemic. Integrated systems of care have some advantages during an epidemic: they may have the financial
resources to better withstand negative revenue shocks, more physical space to separate COVID-19 and non-
COVID-19 patients, and better information technology infrastructure to permit widescale telemedicine. However,
integrated systems may be so focused on acute patients that they fail to keep up with the community-based
population in need. Large integrated systems may also be less in touch with the needs of each individual patient.
Our proposed analysis has three components. First, we will examine how medical treatments differ for patients
in and outside of integrated health systems during the COVID-19 crisis. Measures of treatment will include testing
for COVID-19 as well as medical care receipt apart of COVID-19: visits with health care providers (both in-person
and telemedicine), and maintenance of chronic therapy for those in the community. Second, we will examine
how health outcomes and the experience of care differ for patients in and outside of systems. Some outcome
measures are appropriate for many groups of patients, including death, hospitalization with severe disease, and
patient assessments of the quality of care received. Other outcomes are specific to certain subgroups, including
tumor progression for patients with cancer, changes in site of delivery for pregnant patients, and ability to live
independently for adults and children with physical and mental impairments. Third, we will examine how the
organization of care is changing as a result of COVID-19. To understand this, we will track practice closures
along with mergers of smaller providers into larger systems as the COVID-19 epidemic proceeds.
Our patient analysis will use several sources of data, including Medicare claims, claims records for commercially
insured individuals, and people giving birth in a large state. To track closures, we will use Medicare payment
data along with private sector data on health care consolidation.