Patterns of collaboration among health care and social services providers in communities with lower health care utilization and costs

Objective: To understand how health care providers and social services providers coordinate their work in communities that achieve relatively low health care utilization and costs for older adults.

Study Setting: Sixteen Hospital Service Areas (HSAs) in the United States.

Study Design: We conducted a qualitative study of HSAs with performance in the top or bottom quartiles nationally across three key outcomes: ambulatory care sensitive hospitalizations, all-cause risk-standardized readmission rates, and average reimbursements per Medicare beneficiary. We selected 10 higher performing HSAs and six lower performing HSAs for inclusion in the study.

Data Collection: To understand patterns of collaboration in each community, we conducted site visits and in-depth interviews with a total of 245 representatives of health care organizations, social service agencies, and local government bodies.

Principal Findings: Organizations in higher performing communities regularly worked together to identify challenges faced by older adults in their areas and responded through collective action-in some cases, through relatively unstructured coalitions, and in other cases, through more hierarchical configurations. Further, hospitals in higher performing communities routinely matched patients with needed social services.

Conclusions: The collaborative approaches used by higher performing communities, if spread, may be able to improve outcomes elsewhere.