Many Routes to the Top: Efforts to Improve Care Quality, Coordination, and Costs Through Provider Collaborations

In response to the federal Patient Protection and Affordable Care Act of 2010 (ACA) and a combination of broader market forces, hospitals, physicians, and other providers have been collaborating among themselves and with public and private payers to reform care delivery systems and payment methods. Most of these initiatives aim to slow the growth of health care spending and improve the coordination and quality of patient care.

California providers have been particularly active in developing collaborations with other providers and with commercial health plans. Many of these partnerships have been driven by key market factors characteristic of many California communities — most notably the presence of large providers experienced in managing financial risk for patient care, as well as competitive pressure on both insurers and providers.

This paper describes integration efforts that have proliferated in California since 2013, highlights leading examples from the seven regions studied, discusses collaborators' key goals and strategies, and explores how market conditions spurred each major type of partnership and influenced their structure.