The ties that bind - Interorganizational linkages and physician-system alignment

OBJECTIVES. TO examine the association between the degree of alignment betw een physicians and health care systems, and interorganizational linkages be tween physician groups and health care systems. METHODS. The study used a cross sectional, comparative analysis using a sam ple of 1,279 physicians practicing in loosely affiliated arrangements and 1 ,781 physicians in 61 groups closely affiliated with 14 vertically integrat ed health systems. Measures of physician alignment were based on multiitem scales validated in previous studies and derived from surveys sent to indiv idual physicians. Measures of interorganizational linkages were specified a t the institutional, administrative, and technical core levels of the physi cian group and were developed from surveys sent to the administrator of eac h of the 61 physician groups in the sample. Two stage Heckman models with f ixed effects adjustments in the second stage were used to correct for sampl e selection and clustering respectively. RESULTS. After accounting for sample selection, fixed effects, and group an d individual controls, physicians in groups with more valued practice servi ce linkages display consistently higher alignment with systems than physici ans in groups that have fewer such linkages. Results also suggest that cent ralized administrative control lowers physician system alignment for select ed measures of alignment. Governance interlocks exhibited only weak associa tions with alignment. CONCLUSIONS. Our findings suggest alignment generally follows resource exch anges that promote value-added contributions to physicians and physician gr oups while preserving control and authority within the group.