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VOLUME 49 | NUMBER 3 | JUNE 2014


Patient Loyalty in a Mature IDS Market: Is Population Health Management Worth It?

Keywords: Consumer issues;physician payment; organization and delivery of care.

Objective: To understand patient loyalty to providers over time, informing effective population health management.

Study Setting: Patient care-seeking patterns over a 6-year timeframe in Minnesota, where care systems have a significant portion of their revenue generated by shared-saving contracts with public and private payers.

Study Design: Weibull duration and probit models were used to examine patterns of patient attribution to a care system and the continuity of patient affiliation with a care system. Clustering of errors within family unit was used to account for within-family correlation in unobserved characteristics that affect patient loyalty.

Data Collection: The payer provided data from health plan administrative files, matched to U.S. Census-based characteristics of the patient's neighborhood. Patients were retrospectively attributed to health care systems based on patterns of primary care.

Principal Findings: I find significant patient loyalty, with past loyalty a very strong predictor of future relationship. Relationships were shorter when the patient's health status was complex and when the patient's care system was smaller.

Conclusions: Population health management can be beneficial to the care system making this investment, particularly for patients exhibiting prior continuity in care system choice. The results suggest that co-located primary and specialty services are important in maintaining primary care loyalty.

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