gms | German Medical Science

Background: Cooperation is one of the cores features of integrated healthcare systems and is an important link in the system’s value creating mechanism. The premise is that providers who cooperate can promote more efficient use of health services while improving health outcomes. Cooperation among physicians occurs while actively sharing clinical information in the process of providing care to shared patients. The existence of shared patients can be used to identify information sharing relations among physicians and, hence, can be used to construct physician professional networks of cooperation.

Objectives: To create an evaluation design that describes the evolution of cooperation of an integrated healthcare initiative’s physician network and studies the influence of the integrated care approach over said evolution.

Methods: We constructed the professional cooperation network of physician practices based on their shared patients, using claims data for the years 2004 to 2017. Cooperation was studied at two levels of analysis. At the network level, we used time-series to study the changes in the network structural properties, focusing on network density and the mean minimum distance between any two physicians. At practices level; we studied the evolution of cooperation in a panel model with individual fixed effects of the number of cooperation links and the position of centrality of each node in the cooperation network.

Results: We evidenced a positive evolution of cooperation in the region, led by physicians participating in the integrated initiative. Network density increased by 0.14% on average each year, even though the network grew in number of nodes and diameter. In the same line, mean distance indicator decreased on average ~8% per year. At node level, the number of connections (1.681e-03, p=0.06) and centrality position (0.315e-02, p<0.001) increases more for physicians participating in the integrated care initiative.

Discussion: Practices participating in the integrated initiative increased their relevance in the cooperation network by increasing their centrality and number of connections more than their non-integrated peers. At the same time, the network as a whole evolved into a more cooperative environment. These effects can be linked to two management interventions integrated care initiatives implement to generate value in health systems: An holistic approach to patients’ care needs and using participant physicians to engage patients and to propagate best practices among physicians in the region. The paper presents a valuable design for assessing physician cooperation in a health system.