Organization

The Stephen M. Shortell Center for Organizational Research in the Health Sector Publications

2025 California Primary Care Language Access Survey Report

Executive Summary The 2025 California Primary Care Language Access Survey (CPCLAS) is the first statewide assessment of language access infrastructure within California’s safety-net clinics, addressing a critical data gap as federal protections for Limited English Proficiency (LEP) populations face potential rollback. Leveraging survey data from 101 clinic leaders and 14 in-depth qualitative interviews, the report illuminates the operational realities of Community Health Centers (CHCs) and independent primary care practices serving linguistically diverse communities.

The findings reveal a...

U.S. Primary Care Practice Capabilities Linked to Language Services for Patients with Limited English Proficiency

Stacy Chen
Jenny Guadamuz
Hector P Rodriguez
Karen E Schifferdecker
2025
Background

Patients with limited English proficiency (LEP) experience more challenges with clinician communication than English-proficient patients. U.S. federal policies require the provision of language services, but little is known about language service availability in adult primary care practices nationally.

Objective

To identify primary care physician practice capabilities associated with the routine availability of language services for patients with LEP.

Design

Nationally representative physician practice survey data from the National Survey of Healthcare...

U.S. Primary Care Practice Capabilities Linked to Language Services for Patients with Limited English Proficiency

December 1, 2025

A new study led by CHAMP trainee Stacy Chen along with faculty reveals that nearly half of U.S. primary care practices do not consistently provide professional language services for patients with limited English proficiency (LEP), despite federal requirements mandating their availability. Using data from over 1,200 physician practices, CHAMP researchers found that practices participating in Accountable Care Organizations, those owned by hospitals or health systems, and Federally Qualified Health Centers were significantly more likely to always offer language services...

Health Equity and Hospital Markets: Differences in the Association of Market Concentration and Quality of Care by Patient Race/Ethnicity and Payer

August 30, 2025

As hospital markets across the United States continue to consolidate, a new multi-state analysis done by CHAMP trainee Alexander Adia along with CHAMP faculty Hector Rodriguez suggests that consolidation may have uneven—and sometimes harmful—effects on health equity. The study, which examined hospital market concentration and quality of care across 14 states, underscores the need for regulators to consider equity impacts when evaluating hospital mergers. The analysis found that patients from minoritized racial and ethnic groups, as well as those with noncommercial insurance coverage, faced...

Physician Organization Affiliation With Health Systems and Equitable Care Delivery

October 23, 2025

A new commentary published in JAMA Network Open by CHAMP co-director Dr. Hector Rodriguez highlights concerning findings about health system acquisitions of physician practices and their impact on vulnerable patient populations.

The commentary discusses recent research showing that when physician organizations affiliate with health systems, care disparities between dual-eligible Medicare-Medicaid beneficiaries and other Medicare patients can actually widen for certain quality measures, including diabetic eye examinations and follow-up after acute events.

"These...

Physician Organization Affiliation With Health Systems and Equitable Care Delivery

Hector P Rodriguez
2025

Regulatory agencies need to strike a balance between ensuring competitive health care markets and organizational affiliations that enable better care coordination. Over the past decade, health system acquisition of physician organizations has accelerated, potentially affecting care for socioeconomically and clinically vulnerable populations, including dually enrolled Medicaid and Medicare beneficiaries. Timbie et al present findings from a novel and important study estimating changes in physician organization disparities for dually enrolled beneficiaries before and after affiliation with a...

Mission vs. Margin: The Effects of Catholic Health System Ownership on Hospital Operations

July 24, 2025

Hospitals acquired by Catholic health systems unlikely to eliminate obstetrics, other services, such as reproductive care, may be prohibited

Berkeley, CA — A new study from UC Berkeley School of Public Health researchers shows that Catholic health care systems that acquired hospitals were less likely than their non-Catholic counterparts to eliminate obstetrics care.

The study, published in Medical Care Research and Review, is the first national analysis to rigorously compare how hospital operations change following acquisition by...

Improving The US Health Care System: The Case For Practical Wisdom

Stephen Shortell
Jodi Halpern
Barry Schwartz
2025

A new publication first-authored by CHAMP founder and Professor Emeritus, Stephen Shortell highlights the critical need for a renewed focus on “practical wisdom” in U.S. health care reform.

Despite spending nearly 17 percent of its GDP—totaling $4.9 trillion annually—on health care, the United States continues to rank among the lowest-performing countries in the OECD on key health outcomes. Stark disparities in infant and maternal mortality, hospital safety, and overall care quality persist, especially among minority populations.

The study argues that while numerous reform...

Improving The US Health Care System: The Case For Practical Wisdom

May 30, 2025

A new publication first-authored by CHAMP founder and Professor Emeritus, Stephen Shortell highlights the critical need for a renewed focus on “practical wisdom” in U.S. health care reform.

Despite spending nearly 17 percent of its GDP—totaling $4.9 trillion annually—on health care, the United States continues to rank among the lowest-performing countries in the OECD on key health outcomes. Stark disparities in infant and maternal mortality, hospital safety, and overall care quality persist, especially among minority populations.

The study argues that while numerous reform...

Trends in Screening for Social Risk in US Physician Practices

Amanda Brewster
Hector P Rodriguez
Genevra Murray
Valerie Lewis
Karen Schifferdecker
Elliott Fisher
2025
Abstract

Importance A wealth of research on screening for social risks in health care has emerged, but evidence is lacking on how social risk screening among physician practices has changed over time.

Objectives To evaluate trends in screening for social risks among US physician practices and examine practice characteristics associated with adoption of social risk screening.

Design, Setting, and Participants The main analysis used a repeated cross-sectional design to analyze...