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Physician And Health System Integration

Peter P. Budetti, Stephen M. Shortell, Teresa M. Waters, Jeffrey A. Alexander, Lawton R. Burns, Robin R. Gillies and Howard Zuckerman

Incentives for vertical integration in the health care industry have led many hospitals to consolidate into health systems and profess a desire for closer alignment with affiliated physicians. In this study of fourteen organized delivery systems and their 11,000 physicians in sixty-nine medical groups, we found that many health systems did not align well with physicians. Even systems ostensibly committed to alignment emphasized structural relationships that did not enhance physician-system alignment and paid inadequate attention to issues of importance to physicians. This gap between the goal and reality of physician-system alignment appears to be the result of systems’ responding to a changing mix of policies, not all of which foster integration.


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