Comparative Health System Performance Initiative: Compendium of U.S. Health Systems, 2016, Technical Documentation Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract Number: HHSA290201600001C Prepared by: Mathematica Policy Research, Washington, DC Kirsten Barrett Ken Peckham David Jones Rachel Machta Jessica Heeringa Eugene Rich Laura Kimmey AHRQ Publication No. 17(19)-0047-EF September 2017 (updated January 2019) This page has been left blank for double-sided copying. COMPENDIUM OF U.S. HEALTH SYSTEMS Contents Acknowledgments............................................................................................................................v I. Introduction ..........................................................................................................................1 II. Health System Definition and Data Sources ........................................................................3 A. Working Definition of a Health System ........................................................................3 B. Data Sources ..................................................................................................................3 III. Methodology ........................................................................................................................9 A. Step 1: Matching and Linking Health Systems Across Data Sources ...........................9 1. Automated matching process .................................................................................10 2. Manual review of possible matches based on name and location .........................11 B. Step 2: Identifying Nested Relationships and Aggregating Counts.............................13 1. Identifying SK&A health systems nested within parent health systems ...............13 2. Identifying possible additional nested relationships for manual review ................14 3. Aggregating physician and hospital counts within health systems ........................15 C. Step 3: Applying Exclusion Criteria ............................................................................17 D. Step 4: Conducting Final Manual Review of Consolidated List .................................20 IV. Variables Included in the Consolidated List ......................................................................23 V. Caveats and Limitations .....................................................................................................29 A. Narrow Working Definition of Health System ............................................................29 B. Discrepancies Across Data Sources .............................................................................29 C. Data Collection Methods .............................................................................................30 D. Potential Misalignment of System Definitions Between the Data and the Compendium’s Working Definition ............................................................................30 E. Accuracy of Primary Care Designation .......................................................................30 F. Mergers and Acquisitions ............................................................................................31 Appendix A. QuintilesIMS/SK&A and AHA Methodologies ......................................................33 Appendix B. Automated Matches ..................................................................................................35 Appendix C. Health Systems With Nested Subsystems (Prior to Exclusions) ..............................81 Appendix D. Alternative Payment Models Data and Methods ......................................................89 Appendix E. Insurance Product Data and Methods .......................................................................93 Appendix F. Data Dictionary .......................................................................................................107 iii COMPENDIUM OF U.S. HEALTH SYSTEMS Tables II.1. Potential data sources for health system identification ........................................................4 II.2. Comparison of the Compendium’s working health system definition with HCOS, SK&A, and AHA .................................................................................................................6 II.3. Number of systems contained in each data source ..............................................................7 III.1. Automated match results....................................................................................................11 III.2. Examples of manually matched health systems.................................................................12 III.3. Results of automated matching with manual review .........................................................12 III.4. Summary of matching results ............................................................................................12 III.5. Data sources for generating aggregated counts of physicians and hospitals .....................17 III.6. Definition of exclusion criteria by data source ..................................................................19 III.7. Number of systems excluded from the consolidated list ...................................................20 III.8. Final consolidated list ........................................................................................................21 IV.1. Health system types ...........................................................................................................25 IV.2. Health system attributes included in list ............................................................................27 V.1. Examples of discrepancies in physician counts across data sources .................................30 E.1. Examples of manually matched health systems and MA records ......................................97 E.2. Matches of health systems to CMS MA records using MA parent organization name and address..............................................................................................................................101 E.3. Matches of health systems to CMS MA records using MA organization marketing name and address .......................................................................................................................105 Figures II.1 Data needs to study health systems ......................................................................................4 III.1 Automated and manual matching process .........................................................................10 III.2 Identifying SK&A systems with parent systems ...............................................................14 iv COMPENDIUM OF U.S. HEALTH SYSTEMS Acknowledgments We would like to acknowledge a number of organizations and individuals who provided support and guidance during the development of the Compendium: • AHRQ (Mike Furukawa, Rick Kronick, Dan Miller, Linda Bergofsky, and Jing Guo) • CHSP Initiative Centers of Excellence (Dartmouth, NBER, RAND) • CHSP Technical Expert Panel • Data vendors (QuintilesIMS™and American Hospital Association) • Additional Mathematica Policy Research staff (Linda Molinari, Sarah Anderson, Genna Cohen, Kristen Maurer, Colleen Fitts, Jessica Hegedus, and Margaret Hallisey) v This page has been left blank for double-sided copying. COMPENDIUM OF U.S. HEALTH SYSTEMS I. Introduction In 2015, the Agency for Healthcare Research and Quality (AHRQ) created the Comparative Health System Performance (CHSP) Initiative to study how health care systems promote evidence-based practices in delivering care.i AHRQ’s goal is to understand the factors that affect health systems’ use of patient-centered outcomes research (PCOR) and to identify best practices in disseminating and using PCOR. To achieve AHRQ’s goals, the initiative establishes three Centers of Excellence (CoEs) as well as a Coordinating Center to identify, classify, track, and compare health systems. AHRQ established CoEs at Dartmouth College, the National Bureau of Economic Research (NBER), and the RAND Corporation. Mathematica Policy Research serves as the initiative’s Coordinating Center, working collaboratively with AHRQ and the CoEs to facilitate synthesis of findings on comparative health system performance, build a compendium of U.S. health systems, and support dissemination of the CHSP Initiative findings broadly. A key first step of the initiative is to identify and enumerate health systems. To achieve this objective, AHRQ has developed an initial list of U.S. health systems. This list consolidates information from several data sources, indicating system ownership and provider affiliations with systems and highlighting key system attributes. This consolidated list, referred to as the “list,” is intended to be an initial resource for researchers, policymakers, and other stakeholders who want to identify and describe systems with the ultimate goal of understanding how health systems can improve the cost and quality of health care. The list forms the basis of the Compendium of U.S. Health Systems, which resides on AHRQ’s website (https://www.ahrq.gov/chsp/index.html) and will be updated during the course of the initiative with additional resources to support research on health systems. This document summarizes the approach taken to create the list. In section II, we describe the Compendium’s working definition of a health system and the three key data sources that contributed