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Association between hospital‐physician vertical integration and medication adherence rates
OBJECTIVE: To test the association between vertical integration of primary care providers (PCPs) and adherence rates for anti‐diabetics, renin angiotensin system antagonists (RASA), and statins. DATA SOURCES: Medicare Part B outpatient fee‐for‐service claims and Medicare Part D event data from 2014...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Blackwell Publishing Ltd
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10012217/ https://www.ncbi.nlm.nih.gov/pubmed/36272112 http://dx.doi.org/10.1111/1475-6773.14090 |
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author | Levin, Jonathan S. Komanduri, Swad Whaley, Christopher |
author_facet | Levin, Jonathan S. Komanduri, Swad Whaley, Christopher |
author_sort | Levin, Jonathan S. |
collection | PubMed |
description | OBJECTIVE: To test the association between vertical integration of primary care providers (PCPs) and adherence rates for anti‐diabetics, renin angiotensin system antagonists (RASA), and statins. DATA SOURCES: Medicare Part B outpatient fee‐for‐service claims and Medicare Part D event data from 2014 to 2017. STUDY DESIGN: We estimated difference‐in‐differences regressions, comparing changes in adherence among patients with PCPs who converted from independent to integrated to changes among patients whose PCPs remained independent or integrated during the study period. To test for heterogenous impacts by patient demographics, we estimated triple difference regressions that included additional interaction terms by comorbidity rates, age group, and race/ethnicity. EXTRACTION METHODS: We extracted Medicare claims for adults with continuous enrollment in Parts B and D during the study period. PRINCIPAL FINDINGS: The proportion of patients who had a vertically integrated PCP increased by approximately 23% over the study period. Changes in adherence did not differ significantly between patients based on whether their PCP became integrated (Statins: 0.18, 95% CI −0.13, 0.49; RASA: −0.13, 95% CI −0.46, 0.19; Anti‐Diabetics: −0.20, 95% CI −0.78, 0.38). Among patients with PCPs who became integrated, there were significant decreases in adherence for patients who were Black, Asian, Hispanic, or Native American, above 80 years old, and had greater comorbidities for all three classes. CONCLUSIONS: While there were no average changes in adherence following vertical integration of PCPs, health equity worsened, with significant declines in adherence for Black, Asian, Hispanic, and Native American patients, patients over 80 years old, and patients with greater comorbidities. These findings suggest that integration may reduce clinicians’ incentives to compete based on the quality of care delivered. Given the price increases associated with integration, integration may be a net welfare loss. |
format | Online Article Text |
id | pubmed-10012217 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Blackwell Publishing Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-100122172023-03-15 Association between hospital‐physician vertical integration and medication adherence rates Levin, Jonathan S. Komanduri, Swad Whaley, Christopher Health Serv Res Health Care System Practice and Organization OBJECTIVE: To test the association between vertical integration of primary care providers (PCPs) and adherence rates for anti‐diabetics, renin angiotensin system antagonists (RASA), and statins. DATA SOURCES: Medicare Part B outpatient fee‐for‐service claims and Medicare Part D event data from 2014 to 2017. STUDY DESIGN: We estimated difference‐in‐differences regressions, comparing changes in adherence among patients with PCPs who converted from independent to integrated to changes among patients whose PCPs remained independent or integrated during the study period. To test for heterogenous impacts by patient demographics, we estimated triple difference regressions that included additional interaction terms by comorbidity rates, age group, and race/ethnicity. EXTRACTION METHODS: We extracted Medicare claims for adults with continuous enrollment in Parts B and D during the study period. PRINCIPAL FINDINGS: The proportion of patients who had a vertically integrated PCP increased by approximately 23% over the study period. Changes in adherence did not differ significantly between patients based on whether their PCP became integrated (Statins: 0.18, 95% CI −0.13, 0.49; RASA: −0.13, 95% CI −0.46, 0.19; Anti‐Diabetics: −0.20, 95% CI −0.78, 0.38). Among patients with PCPs who became integrated, there were significant decreases in adherence for patients who were Black, Asian, Hispanic, or Native American, above 80 years old, and had greater comorbidities for all three classes. CONCLUSIONS: While there were no average changes in adherence following vertical integration of PCPs, health equity worsened, with significant declines in adherence for Black, Asian, Hispanic, and Native American patients, patients over 80 years old, and patients with greater comorbidities. These findings suggest that integration may reduce clinicians’ incentives to compete based on the quality of care delivered. Given the price increases associated with integration, integration may be a net welfare loss. Blackwell Publishing Ltd 2022-11-08 2023-04 /pmc/articles/PMC10012217/ /pubmed/36272112 http://dx.doi.org/10.1111/1475-6773.14090 Text en © 2022 RAND Corporation. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Health Care System Practice and Organization Levin, Jonathan S. Komanduri, Swad Whaley, Christopher Association between hospital‐physician vertical integration and medication adherence rates |
title | Association between hospital‐physician vertical integration and medication adherence rates |
title_full | Association between hospital‐physician vertical integration and medication adherence rates |
title_fullStr | Association between hospital‐physician vertical integration and medication adherence rates |
title_full_unstemmed | Association between hospital‐physician vertical integration and medication adherence rates |
title_short | Association between hospital‐physician vertical integration and medication adherence rates |
title_sort | association between hospital‐physician vertical integration and medication adherence rates |
topic | Health Care System Practice and Organization |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10012217/ https://www.ncbi.nlm.nih.gov/pubmed/36272112 http://dx.doi.org/10.1111/1475-6773.14090 |
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