August 2020 – Onpoint provided lead analytic support in a recent study of informal provider networks operating in the California healthcare market for a report commissioned by the state’s health benefits exchange, Covered California. Onpoint’s analytics team worked with California’s Integrated Healthcare Association (IHA) to design and execute the study, seeking insight into the associations that exist among California’s fee-for-service (FFS) healthcare providers.

The objective of the study, undertaken in collaboration with IHA and Covered California and with consultation from Elliot Fisher, a researcher and professor from The Dartmouth Institute, was to identify informal networks within a FFS environment and to measure the performance of these networks across an array of cost, utilization, and quality metrics.

Project analysts utilized claims data spanning multiple years for the commercial PPO and Medicare FFS populations to identify linkages between clinicians based on shared patients. A statistical grouping software package in R determined the structure of the informal provider networks within geographical areas, yielding more than 150 unique provider networks across the state of California. The networks had varying levels of affiliation with existing provider organizations. Analysts then attributed patients to the networks, measured the performance of the networks, and compared each network’s performance with the overall network average as well as with statewide averages for the full commercial PPO and Medicare FFS populations included in IHA’s Cost and Quality Atlas reporting.

In follow-on analyses, we expect to gain more insight into how the output of this study can be used to support payers when entering into value-based contracting arrangements with the informal networks not already affiliated with existing provider organizations – with the ultimate goal of improving cost, quality, and healthcare outcomes.

Figure 1. One of 40 Informal Networks Identified in the San Francisco Core-Based Statistical Area