“Integrated Delivery Networks: In Search of Benefits and Market Effects,” by Jeff Goldsmith, Lawton Burns, Aditi Sen, and Trevor Goldsmith, is a great literature review and summary of the consequences of certain kinds of consolidation and integration in health care markets. The authors conclude that the case that integrated delivery networks (IDNs) offer better care at lower costs is weak.
IDNs have also operated under a halo of presumed societal benefits (quality, efficiency, care integration, etc.) for the better part of four decades with remarkably little evidence that these benefits in fact exist.
It is still possible that these societal benefits of IDNs exist. But if they do, given the opacity of present IDN disclosure of key operating information, they eluded us in this preliminary investigation. If public policy is to continue fostering IDN growth and development, a more solid evidentiary foundation for this form of medical care organization seems essential. The mere presumption of societal benefits of IDN formation or operations is no longer tenable as a policy principle.
For those interested in vertical integration in health care, particularly that of providers and plans, see also this McKinsey report. Apart from my own paper with Steve Pizer and Roger Feldman, these two reports, and the small amount of relevant literature they reference, are the only evidence-based publications on provider-plan integration I’m aware of.
UPDATE: A related round-up is here.