Project Summary Improving the quality of care for patients with multiple chronic conditions (MCCs) continues to be a national priority. Concurrently, hospital-physician vertical integration – namely, hospitals acquiring independent physician practices, directly employing physicians, or having significant financial ties to physician practices – has become commonplace. Prior research has largely shown hospital-physician integration to be associated with higher healthcare costs with mixed effects on quality and utilization outcomes. However, no known study has examined the effect of hospital-physician vertical integration on outcomes for patients with MCCs, who tend to be costly, high utilizers of health care. To address this gap and inform future policymaking, we will examine the association between hospital-physician vertical integration and costs, quality, and health services utilization for patients with MCCs. To meet the objectives, Aim 1 will evaluate the association between hospital-physician vertical integration and health services utilization for an insured panel of patients with MCCs, while Aims 2 and 3 will evaluate the effect of this type of vertical integration on costs and quality, respectively. We will use data from four sources: 1) the Virginia All-Payer Claims Database (VA APCD), a longitudinally linked state-level database consisting of de-identified patient-level medical and pharmacy claims for millions of Virginia residents with commercial, Medicaid, and/or Medicare coverage 2) the Medicare Data on Provider Practice and Specialty (MD-PPAS) file, a data repository of specialties, practice affiliation, demographics, and geography for more than 1 million providers 3) the American Hospital Association Annual Survey, a nationally representative survey of more than 6,000 hospitals and 400 health systems that will be used to define hospital-level covariates, and 4) the American Community Survey (ACS), a publicly-available survey database that includes 5-digit zip code-level data related to neighborhood-level socioeconomic status, such as median household income, educational attainment, and poverty status. The study aligns with AHRQ’s mission and strategy by addressing two priority areas: 1) research that advances whole-person, 360-degree care for those with MCCs and/or socioeconomic disadvantage, and 2) harnessing data to contribute novel information about the accessibility and affordability of health care by examining how hospital-physician vertical integration (an innovative market approach) is impacting care delivery and financing.