Health care fragmentation occurs when a patient sees many different providers and does not see a single provider for a substantial portion of their visits. The result is a lack of coordination and continuity in the delivery of health care services. The lack of integration can result in disjointed and inefficient health care delivery and poor health care decisions, negatively impacting the patient experience, outcomes, and overall health care system performance.
Key aspects of health care fragmentation include:
- Provider Disconnection: Fragmentation can occur when health care providers, such as primary care physicians, specialists, hospitals, and other care facilities, operate independently and do not effectively communicate or share patient information. A series of studies conducted by Mathematica with support from the Centers for Medicare & Medicaid Services (CMS) shows that high levels of fragmented care persist despite providers’ increased use of electronic health records.
- Care Transitions: Fragmentation often becomes evident during transitions of care, such as when a patient moves from a hospital to a rehabilitation facility or returns for home care. Poor communication and coordination during these transitions can lead to gaps in care and increased risks.
- Disease Management: In chronic disease management, fragmentation may occur when different specialists manage different aspects of a patient’s condition without effective collaboration. According to the NIH, individuals with chronic illnesses experience high rates of care fragmentation because they often require lifelong continuous care. Over time, the services they receive from health care practitioners may be limited or redundant, and they may fall into transitional care gaps between health care institutions.
- Access Barriers: Fragmentation can contribute to challenges in accessing necessary health care services. Patients may face difficulties in navigating the health care system and obtaining timely appointments or referrals.
- Duplication of Services: Lack of coordination can lead to unnecessary duplication of medical tests, procedures, or interventions, increasing health care costs and potentially exposing patients to avoidable risks.
Over the years, efforts to reduce health care fragmentation have included measures to improve care coordination at the primary care level, increase information sharing via health information exchange (HIE) networks, and promote a patient-centered approach to health care delivery. However, Mathematica and CMS research suggests that initiatives aimed at improving continuity, coordination, and comprehensive care in general may need to focus on a broader range of providers outside of the primary care environment in order to be effective. The study’s authors urge that care systems align incentives across specialists, primary care physicians, and other health care entities to reduce fragmentation, increase coordination, and give additional support to improve provider communication. Furthermore, they suggest that treatments should be tailored to target fragmented care precisely.
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