Integrating Payor-Segregated Outpatient OBGYN Care Models: The Clinician Perspective

Area of Science:

• Health Services Research
• Health Equity
• Academic Medicine

Background:

• Racial disparities in maternal and gynecologic health outcomes are significant in the U.S.
• Ambulatory care settings may contribute to these disparities.
• Academic medical centers often segregate care by insurance payor, leading to de facto racial segregation.

Purpose of the Study:

• To explore clinician perspectives on payor-segregated ambulatory care delivery.
• To assess clinician opinions on integrating resident and attending physician sites.
• To identify barriers and facilitators to care integration in academic medical centers.

Main Methods:

• Semi-structured interviews were conducted with attending physicians and advanced practice providers (APPs).
• Interviews focused on perceived value of current model, attitudes toward integration, and barriers/facilitators.
• Data analysis used grounded theory with inter-coder reliability (k = .90).

Main Results:

• Clinicians recognized some value in the segregated system but supported integration as a moral imperative.
• Concerns included patient-clinician continuity, trainee acceptance, mission-driven care erosion, and potential racist interactions.
• Clinicians emphasized the need for resources and small-scale trials before full integration.

Conclusions:

• Clinicians are unified on integrating ambulatory care but the implementation path is unclear.
• This study offers insights into ambulatory OBGYN care disparities.
• Findings may guide health systems considering care integration to improve equity.