Physician Referrals, Delivery System Reform, and The Diffusion of Information

Pilot Project

Physician Referrals, Delivery System Reform, and The Diffusion of Information

ACOs, Bundled Care, Patient-Centered Medical Homes and Physician Referrals

Abstract: Physician-to-physician referrals play a central role in the health care systems and are drives of costs and quality. There is evidence that referrals are currently misused and overused and recognition that they will have to change if health reform objectives such as care coordination and cost reduction are to be achieved (Son et al., 2014). Indeed, many of the models of care supported by the Affordable Care Act (e.g., accountable care organizations (ACOs), patient-centered medical homes, bundled payments) depend on physicians making high-value referrals. Yet there remains little evidence on what physician referral networks look like, how physicians make decisions about referrals, or how to motivate changes in these practices to align with new models of care delivery. This project will contribute to filling this gap.

There are two overall goals for this project. First, we will apply techniques and methods from social network analysis and standard economics to map out primary care physician referral networks in the greater Philadelphia area, evaluate the characteristics of these networks (e.g., size, concentration), and assess the determinants of physician referrals. Second, we will study the role of referral networks in two aspects of health reform: the introduction of new delivery systems such as ACOs, which are like to require changes in referral practices, and the dissemination of evidence-based guidelines to promote high value care. The results of this research will offer new evidence on physician referral practices and have the potential to inform policymaking around delivery system reform and the diffusion of evidence-based medicine and other reforms across physician networks.