# Integrated health systems, market concentration, and socioeconomic disparities in quality of care

> **NIH AHRQ R01** · RAND CORPORATION · 2022 · $399,739

## Abstract

Project Summary/Abstract
Americans at opposite ends of the socioeconomic spectrum differ in life expectancy by 10 to 15 years.
Socioeconomic status (SES) and other social determinants of health (SDOH), such as employment, stable
housing, and access to healthy food, explain much of these differences. However, numerous studies also show
that low-income patients receive worse medical care than high-income patients across a wide range of quality
measures. Many low-SES patients receive care from physician organizations (POs) that have fewer resources
to care for patients with complex health and social needs, including multidisciplinary care teams and advanced
health information technology, compared with POs serving higher-income patients. Meanwhile, integrated
health systems, health care organizations that own both hospitals and POs, are expanding across the country
with potentially far-reaching changes in how medical care is delivered. POs owned by health systems may be
well-positioned to support initiatives that address SDOH through access to capital that could support
infrastructure improvements, better access to specialty care for their patients, and better coordination across
care settings. However, prior studies have shown that health system-ownership of POs has little to no effect on
quality, is associated with higher spending, and may lead to worse patient experiences. It is not known whether
POs that treat low SES patients are joining health systems or how health system ownership affects care for low
SES patients. The specific aims of this study are to: (1) assess trends in health system ownership of POs that
serve patients with low SES; (2) assess the impact of health system ownership of POs on SES disparities in
access to care and quality of care; (3) decompose the effects of ownership changes on SES disparities into
within-PO and between-PO effects; and (4) identify mechanisms through which health system-owned POs and
independent POs achieve reductions in SES disparities. The proposed study builds on research conducted by
the investigators as part of an AHRQ-funded Center of Excellence on Health System Performance that
explored the impact of hospital ownership changes on quality of care, racial and ethnic differences in quality of
care between heath system-owned POs and independent POs, and efforts to achieve clinical integration by
safety net providers. The study will provide policymakers with timely information about the potential benefits or
unintended consequences for vulnerable populations of PO ownership by health systems and the role of
physician market concentration and other market characteristics in explaining trends in SES disparities.
Primary data collection from 30 POs and their community partners will identify the specific strategies that POs
are using to reduce SES disparities and to determine the value added of health system ownership.

## Key facts

- **NIH application ID:** 10489702
- **Project number:** 5R01HS027782-03
- **Recipient organization:** RAND CORPORATION
- **Principal Investigator:** Justin W. Timbie
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2022
- **Award amount:** $399,739
- **Award type:** 5
- **Project period:** 2020-09-30 → 2024-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10489702

## Citation

> US National Institutes of Health, RePORTER application 10489702, Integrated health systems, market concentration, and socioeconomic disparities in quality of care (5R01HS027782-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10489702. Licensed CC0.

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