IT’S BEEN A common claim that integrating health care services into a consolidated system would yield better outcomes for patients and be able deliver that care more efficiently at lower cost. 

But a new study says it just isn’t so. 

In one of the first large-scale analyses of both Medicare and commercially-insured patients in US health care systems, Harvard researchers say the promise of health care systems has not been realized. The study, published in JAMA, found that the quality of care was “marginally better” for patients treated in health care systems while the costs of such services were substantially higher.

“Overall, systems really haven’t lived up to the promise of better quality and lower cost,” said David Cutler, a professor of economics at Harvard and senior author of the report. 

The study looked at 580 health care systems across the country. To meet that definition, a system had to include at least one acute care hospital, 50 physicians, and at least 10 primary care doctors working in the same region. The study compared outcomes and costs at health care systems with care delivered by hospitals and doctors not part of such systems. 

Overall, 40 percent of US physicians work in health care systems and 84 percent of all general acute care hospital beds are in systems. The study found modest differences in measures of health care quality like routine administration of flu shots and pneumonia vaccines, and following established guidelines for cardiovascular and diabetes care. But the better performance of health care systems was “small in magnitude.” There were, however, big cost differences, with prices 12 to 26 percent higher for physician services in health care systems and 31 percent higher for hospital services in such systems compared with non-system care.

When the researchers adjusted the results to account for physician practice size, the price differences were smaller, but remained high for small and medium-sized health systems. 

Cutler, who specializes in health care and sits on the state Health Policy Commission, said the findings represent another cautionary tale to Massachusetts officials dealing with the merger and consolidation efforts that have characterized the state’s health care landscape. 

“As a state, we should continue to be skeptical of claims that consolidation is obviously going to be good,” said Cutler, who chairs the commission’s market and oversight transparency committee. He said the approach to health care players pursuing such mergers should be, “You’ve got to show us the evidence.”




Gambling expansion: The Massachusetts Gaming Commission, on a 4-1 vote, allows Encore Boston Harbor to expand its gambling operations in Everett to a new property under development across the street from the company’s existing casino.

– The decision means Encore, which is owned by Wynn Resorts, can now move forward in the regulatory process with an east of Broadway proposal calling for a theater, a nightclub, a parking garage, and rooms for sports betting and poker. The new facility would be connected to the existing one by a footbridge across Broadway. Read more.

No more lame duck: Some Senate Democrats appear to be on the fence about doing away with an eight-year term limit for the position of Senate president. Still, the measure is expected to easily pass. Sen. Will Brownsberger said the president needs an indefinite tenure to avoid lame duck status and “in order to be strong.” Read more.

Flagging support: A MassINC Polling Group survey of Massachusetts voters indicates the popularity of Democratic officials in the state is sagging and some, even though they are powerful players on the national stage, are barely known here. Read more.

No more Biden: President Biden also fares poorly in the new poll, with only 22 percent of Massachusetts voters wanting him to run again. Read more.


Overhaul DCF: Michael Dsida of the Committee for Public Counsel Services says it’s time to overhaul the Department of Children and Families – Band-Aids will no longer do. Read more.

US history requirement: Jamie Gass of the Pioneer Institute urges Massachusetts to restore the US history MCAS as a graduate requirement. Read more.




Child care may finally get some attention on Beacon Hill, where there seems to be momentum behind efforts to inject state funding into the sector, where pay is low and demand for slots is high. (Boston Globe


An effort to juice up Boston’s new “participatory budgeting” process with more members and pay for those taking part fell short in a City Council vote. (Boston Herald


A report from a nonprofit advocacy group charges that St. Vincent Hospital in Worcester has failed to meet federal regulations on disclosure of pricing of services. The group said two other hospitals also owned by Tenet Healthcare, MetroWest Medical Center in Framingham and MetroWest Medical Center – Leonard Morse Hospital in Natick, also failed to adequately disclose prices. (Worcester Telegram)  


Something about Marty Walsh’s reported imminent exit as labor secretary to take the multimillion-dollar-paying post of head of the NHL players’ union “doesn’t smell right,” writes Robert Kuttner in the American Prospect. He says the job offer at least partially resulted from Walsh’s close ties to NHL management through Boston Bruins owner Jeremy Jacobs, and also says the White House was “blindsided” by the news and its poor timing just before President Biden’s State of the Union speech. 

The future of Social Security is back on the DC radar after President Biden charged in his State of the Union speech that some Republicans want to cut the program. (Washington Post)


Pittsfield Mayor Linda Tyer is playing it coy about whether she’ll seek a third term this fall. (Berkshire Eagle


The newest union members in labor’s effort to secure growth in new sectors: dorm assistants at Boston University, who voted to join SEIU Local 509. (Boston Globe


Former Everett school superintendent Frederick Foresteire took the stand in his defense against indecent assault and battery charges. (Boston Globe)


Five Western Mass. communities and the Northwestern district attorney’s office are taking part in a “restorative justice” program that aims to bring accountability for criminal acts without arrests. (Daily Hampshire Gazette)

Juvenile delinquency rates spiked in the wake of the pandemic, according to a new report. (Salem News


Boston Magazine has a whopper of a story reporting that a years-long campaign by the Everett Leader Herald against Everett Mayor Carlo DeMaria was fueled by stories in which the paper’s editor, Josh Resnek, made up quotes and reported on kickback payments to the mayor in stories that Resnek now says were just expressions of his opinion. 


Globe columnist Yvonne Abraham offers a tribute to Chris Condon, a beloved union organizer and political strategist, who died at age 46.