Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration
The NIHCM Foundation is a nonprofit, nonpartisan organization dedicated to improving the effectiveness, efficiency and quality of America's health care system.
  • Data Insights

    Mental illness is increasingly common among young people but many are not receiving the treatment that they need. This Data Insights explores current trends in youth mental health and opportunities to improve outcomes.

    Learn More
  • Grants

    NIHCM Foundation has awarded 14 grants for health care journalism including investigative reporting and educational opportunities for reporters.

    Press Release All Journalism Grantees
  • Awards

    NIHCM Foundation is pleased to welcome Dr. Karen DeSalvo, Dr. Aaron E. Carroll and Eliza Barclay to the independent judges panel of the NIHCM Awards. All three bring considerable expertise to the prestigious panel.

    Press Release Judges Panels The NIHCM Awards
  • Grants

    NIHCM Foundation has awarded over $500,000 in grants to support nine investigator-initiated research studies.

    Press Release All Research Grantees
  • Briefing

    NIHCM Foundation led a briefing on Capitol Hill to discuss social determinants of health and the opioid crisis with Founding President and CEO Nancy Chockley, former CMS Administrator Don Berwick, Curtis Barnett of Arkansas Blue Cross Blue Shield, Craig Samitt of Blue Cross and Blue Shield of Minnesota, and Grant Baldwin from the CDC.

    Press Release Watch the Video
  • Advisory Board

    NIHCM Foundation is pleased to welcome Dr. Scott Gottlieb, Sherry Glied, PhD, and Katherine Baicker, PhD, to its distinguished Advisory Board. Their ideas and insights will advance NIHCM's mission to improve health care for millions of Americans.

    Press Release Advisory Board
  • News

    NIHCM welcomed Secretary Azar to a meeting in March to discuss efforts by the Department of Health and Human Services to transform health care by lowering costs and improving value for patients.

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Events

February 24, 2020
Teen-Mental-Health-webinar-graphic

This webinar explored cross-sector strategies to prevent teen substance and suicide, as well as the role of school-based health services in providing behavioral health care.

January 27, 2020
SDOH-webinar-graphic-012720

This webinar explored public and private sector efforts to improve health outcomes by addressing social determinants of health.

In the News

February 2020
Population Health Spotlight
newsletter-alcohol-deaths-v2

How Are Health Care Prices Related to Physician Practice Consolidation and Integration with Hospitals?

Why These Studies Are Important

Health care providers of all types are rapidly consolidating to form larger organizations. An extensive body of research has demonstrated that hospital consolidation is associated with significantly higher prices for hospital services, with little beneficial impact on quality of care. NIHCM grantee Dr. Laurence Baker and colleagues have extended this provider consolidation research by looking at the price effects of the growing vertical integration between hospitals and physician practices and of the ongoing consolidation of physician practices into larger and larger group practices. Four papers have been published to date from this work.

What The Studies Found

  • An increase in the market share of hospitals owning physician practices was associated with higher hospital prices and higher spending for privately insured patients.1
  • Depending on the specialty, the prices paid by private PPOs for office visits were 8 to 16 percent higher in counties with the highest concentration among physician practices than in those on the lower end of the spectrum. Markets that began the study period with less competition among practices also experienced larger price increases over the next 8 years.2
  • Private prices for a range of common surgical and medical procedures were 8 to 26 percent higher in counties with the least competition among physician practices, relative to the counties with high levels of competition.3
  • Increases in the degree of concentration of orthopedic practices over the 2001-2010 period were associated with an increase of about 7 percent in the prices paid by private insurers for total knee arthroscopy, largely offsetting the secular decline in physician fees occurring over the period absent changes in market concentration.4

What These Findings Mean

  • Individually, and collectively, these studies add to the literature raising concerns about growing provider consolidation.
  • Unchecked consolidation by providers can confer appreciable market power that results in higher prices.

More About The Studies

These studies used multiple years of commercial health care claims spanning U.S. markets and examined county-level or other market variation in provider integration measures and private prices. Full details on methods can be found in the articles cited below.

Full Citations

1. Baker LC, Bundorf MK, and Kessler DP. “Vertical Integration: Hospital Ownership of Physician Practices is Associated with Higher Prices and Spending,” Health Affairs, 33(5):756-63, 2014.
2. Baker LC, Bundorf MK, Royalty AB, and Levin Z. “Physician Practice Competition and Prices Paid by Private Insurers for Office Visits,” The Journal of the American Medical Association, 312(16):1653-62, 2014.
3. Austin DR and Baker LC. “Less Physician Practice Competition Is Associated With Higher Prices Paid for Common Procedures,” Health Affairs, 34(10):1753-60, 2015.
4. Sun E and Baker LC. “Concentration In Orthopedic Markets Was Associated With A 7 Percent Increase In Physician Fees For Total Knee Replacements,” Health Affairs, 34(6):916-21, 2015.

For more information about these studies, contact Dr. Laurence Baker at laurence.baker[at]stanford.edu.
For more information about the NIHCM Foundation Investigator-Initiated Research Grant Program, contact Dr. Julie Schoenman at 202-296-4426.

Read More

Dr. Laurence Baker and his colleagues, with support from NIHCM research grants, have produced a series of papers examining the relationship between provider market power and private prices in a variety of scenarios. This Research Insights highlights the key takeaways from four published papers.

Events

February 24, 2020
Teen-Mental-Health-webinar-graphic

This webinar explored cross-sector strategies to prevent teen substance and suicide, as well as the role of school-based health services in providing behavioral health care.

January 27, 2020
SDOH-webinar-graphic-012720

This webinar explored public and private sector efforts to improve health outcomes by addressing social determinants of health.

In the News

February 2020
Population Health Spotlight
newsletter-alcohol-deaths-v2

Grants

Journalism GrantsJournalism Grant Program

We are no longer accepting letters of inquiry for the 2019-2020 round of grantmaking. NIHCM will notify grant winners in November 2019.

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Investigator-Initiated Research Grant Program

Nine new grantees for the 2019-2020 funding cycle have been announced! We will begin accepting Letters of Inquiry for the 2020-2021 funding cycle in late spring 2020.

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Awards

Now Accepting Entries for the 26th Annual Research and Journalism Awards

Winners Announcment 2018 1

Submit your research or reporting published in 2019 by February 3, 2020 for a chance to win up to $20,000. Winners and finalists will be recognized at a dinner in Washington, D.C., in May 2020.

Learn More and Apply