If you read the local papers or any recent state government reports you likely have the impression that Partners HealthCare is like PAC Man, gobbling up market share at every turn. What are the facts? In 2014, the most recent year for which state CHIA data are available, Partners inpatient market share was just over 18%. That means Partners cares for fewer than 1 in 5 of the hospital patients in the state, hardly a monopoly. In eastern Massachusetts our market share is 22%. Has Partners been getting bigger? No. We have the same statewide market share today that we had 10 years ago.
And our physician network, a very important source of patient referrals, has actually gotten smaller since 2012 even when you consider the addition of Harbor Medical Associates last year. Today, Partners has 20% fewer physicians than it did in 2012. What happened to these physicians? They joined other hospitals and systems including Steward, Beth Israel Deaconess, Atrius, and Lahey. Our proposals to affiliate with Hallmark Health and South Shore Hospital were attempts to strengthen and rebuild our network so that it is geographically diverse, meets the needs of patients and employers, and makes sense for the population-based care that state law and the Affordable Care Act expect us to provide. The recent announcement of a merger between MGH and Wentworth-Douglass Hospital (WDH) in New Hampshire is part of this effort and a reflection of WDH’s desire to draw on Mass General expertise to enhance their specialty programs.
In addition, the resurgence of risk contracting, in which a provider is accountable for the full cost of care, creates an incentive for each provider to keep and manage care within its network.
There are signs that both of these facts – a smaller Partners MD network, and more risk contracting – are influencing patient flow and our volume of out-of-network referrals is declining, down 11% for inpatient and 15% for outpatient since FY 11. Testimony by Beth Israel Deaconess Care Organization (BIDCO) at the 2015 cost trends hearing illustrated this. They said that when Cambridge Health Alliance joined BIDCO in January 2014, their admissions to Partners facilities declined by 35%. Not a desired outcome from our perspective, but evidence that the market is correcting itself, as intended.
This article is a part of a Partners HealthCare Facts Series. Check back with Connect with Partners often to see more in this series or subscribe below to have the latest updates emailed to you.