Developing Indicators of Care Fragmentation That Predict Service Utilization by High-Need, High-Cost Patients

Patients with several chronic conditions experience adverse health events and receive unnecessary care at especially high rates, at least partly from having many visits with multiple providers. If health care organizations could identify instances in which this fragmentation of care creates an excessively high risk of problems occurring, then providers might be able to intervene to improve communication, care management, and, ultimately, patients’ outcomes. This project will support exploratory research to develop and test multiple definitions of fragmentation to determine which one most accurately predicts overuse of care. Drawing from a multipayer dataset covering New York’s Mid-Hudson Valley, the research team also will compare characteristics and utilization patterns of patients insured by Medicare, Medicaid, and commercial plans. These analyses will inform development of a novel measure of care fragmentation that could help improve interventions for some of the most complex and costly patients.