Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Med Care. 2013 Aug;51(8):715-21. doi: 10.1097/MLR.0b013e3182977991.
Physicians naturally form networks. Networks could form a rational basis for Accountable Care Organizations (ACOs) for defined populations of Medicare beneficiaries.
To use methods from network science to identify naturally occurring networks of physicians that might be best suited to becoming ACOs.
RESEARCH DESIGN, SUBJECTS, AND MEASURES: Using nationally representative claims data from the Medicare program for CY 2006 on 51 hospital referral regions (HRRs), we used a network science-based community-detection algorithm to identify groups of physicians likely to have preestablished relationships. After assigning patients to networks based upon visits with a primary care physician, we examined the proportion of care delivered within communities and compared our results with potential ACOs organized around single hospitals.
We studied 4,586,044 Medicare beneficiaries from 51 HRRs who were seen by 68,288 active physicians practicing in those HRRs. The median community-based network ACO had 150 physicians with 5928 ties, whereas the median hospital-based network ACO had 96 physicians with 3276 ties. Among patients assigned to networks via their primary care physicians, seventy-seven percent of physician visits occurred with physicians in the community-based networks as compared with 56% with physicians in the hospital-based networks; however, just 8% of specialist visits were to specialists within the hospital-based networks as compared with 60% of specialist visits within the community-based networks. Some markets seemed better suited to developing ACOs based on network communities than others.
We present a novel approach to identifying groups of physicians that might readily function as ACOs. Organic networks identified and defined in this natural and systematic manner already have physicians who exhibit close working relationships, and who, importantly, keep the vast majority of care within the networks.
医生自然会形成网络。这些网络可以为医疗保险受益人群的责任医疗组织（ACO）提供合理的基础。
使用网络科学方法来识别可能最适合成为 ACO 的自然形成的医生网络。
研究设计、主体和措施：利用来自 Medicare 计划 2006 年 CY 的全国代表性索赔数据，对 51 个医院转诊区（HRR），我们使用基于网络科学的社区检测算法来识别可能具有预先建立关系的医生群体。在根据与初级保健医生的就诊情况将患者分配到网络之后，我们检查了社区内提供的护理比例，并将我们的结果与围绕单一医院组织的潜在 ACO 进行了比较。
我们研究了来自 51 个 HRR 的 458.6044 名 Medicare 受益人，这些受益人由在这些 HRR 中执业的 68288 名活跃医生治疗。基于社区的网络 ACO 的中位数有 150 名医生，有 5928 个联系，而基于医院的网络 ACO 的中位数有 96 名医生，有 3276 个联系。在通过初级保健医生分配给网络的患者中，与社区网络中的医生相比，77%的医生就诊发生在社区网络中，而与医院网络中的医生相比，这一比例为 56%；然而，只有 8%的专科就诊是在医院网络中的专科医生处就诊，而在社区网络中，这一比例为 60%。一些市场似乎比其他市场更适合基于网络社区发展 ACO。
我们提出了一种识别可能容易作为 ACO 运作的医生群体的新方法。以这种自然和系统的方式识别和定义的有机网络已经有了密切合作关系的医生，重要的是，他们将绝大多数护理保持在网络内。
