Outcomes and Effectiveness Research
Faculty and Staff
Lawrence Casalino, M.D., Ph.D., is Chief of the Division of Outcomes and Effectiveness Research and The Livingston Farrand Associate Professor of Public Health in the Department of Public Health at Weill Cornell Medical College. He came to Cornell after nine years at the University of Chicago, where he was a tenured associate professor. Previously, he worked for 20 years as a family physician in private practice in Half Moon Bay, California. During that time he obtained a Ph.D. in Health Services Research at the University of California, Berkeley, with an emphasis on organization theory, institutional sociology, and institutional economics.
Dr. Casalino is interested in comparative effectiveness research focused on the health care delivery system. Put simply, this means asking: which types of organizations, using which types of processes, provide higher quality, cost-effective care? For example: at present, large numbers of primary care and specialist physician practices are being purchased by hospitals. Does this lead to higher or lower quality care? Higher or lower cost care? Delivery system comparative effectiveness research also asks: what are the effects of incentives created by public and private payors in influencing the types of organization that succeed (and thus become more prevalent) and the processes they use to provide care? Dr. Casalino is particularly interested in unintended consequences of policies and in the effects of policies and of the organization of practice on physician professionalism and on racial/ethnic and socioeconomic disparities in health care delivery.
At present, Dr. Casalino is working on projects that (1) seek to define the demography of physician practices in the U.S., to describe the processes used by practices to improve care, and to analyze which factors are related to increased use of such processes; (2) analyze the relationship between different types or practices, different types of processes, and the quality and cost of care provided; (3) seek to identify physician referral networks, describe their characteristics, and analyze which types of network provide better care; (4) analyze the effect of pay for performance programs on physician practices located in sociodemographically disadvantaged areas; (5) analyze the effects of a large program that helps small practices in disadvantaged areas install electronic medical records and use them to improve care; (6) explore ways in which the primary care workday might be transformed.
Dr. Casalino is the recipient of an Investigator Award in Health Policy Research from the Robert Wood Johnson Foundation. He has served on numerous national committees and as chair of the Academy Health Annual Research Meeting. He has worked extensively with the Federal Trade Commission and with physician groups and hospitals on anti-trust issues related to clinical integration of physicians and of physician-hospital organizations.Education
M.D., University of California, San Francisco, 1979
M.P.H., University of California, Berkeley, 1992
Ph.D., University of California, Berkeley, 1997
Clinical Expertise
Family Practice
Research Profile
Dr. Casalino has focused on several research methods, including medical record review, surveys, and interviews and case studies. In addition, he has written a number of conceptual articles and reports intended to introduce new problems and/or to help provide new frameworks for thinking about problems.
His conceptual articles have helped to increase awareness of (1) the potential for quality measurement to have unintended, undesirable consequences; (2) the potential for pay for performance and public reporting programs to increase racial/ethnic and socioeconomic disparities in health care delivery; (3) the conflict between disease management programs based in physician organizations and those operated by health plans, and the possible consequences of this conflict; (4) the lack of data on the organization of physician practice and on the effects of this organization; (5) the potential for Medicare to act to encourage the development of “Accountable Care Systems.”
Dr. Casalino’s empirical work has provided new information about (1) the organization of physician practice and about physicians’ use (or lack of use) of organized processes to improve the quality of care; (2) physician-hospital relations; (3) hospital strategies; (4) pay for performance programs; (5) the cost to physician practices of interactions with health plans; and (6) the frequency with which physicians fail to inform patients of clinically significant abnormal outpatient test results, and the processes that may reduce this frequency.
Selected publications:
- Robinson, James C and Lawrence Casalino. 1995. "The Growth of Medical Groups Paid through Capitation in California." New England Journal of Medicine 333(25):1684-1687.
- Casalino, Lawrence P. 1999. "Unintended Consequences of Measuring Quality on the Quality of Medical Care." New England Journal of Medicine 341(15):1147-1150.
- Casalino, Lawrence, Robin R Gillies, et al. 2003. "External Incentives, Information Technology, and Organized Processes to Improve Health Care Quality for Patients with Chronic Diseases." Journal of the American Medical Association 289(4):434-441.
- Casalino, Lawrence P, Kelly Devers, Timothy Lake and Jeffrey Stoddard. 2003. "Benefits of and Barriers to Large Medical Group Practice." Archives of Internal Medicine 163(16):1958-1964.
- Casalino, Lawrence P, Kelly J Devers and Linda R Brewster. 2003. "Focused Factories? Physician-Owned Specialty Facilities." Health Affairs 22(6):56-67.
- Casalino, Lawrence P, Hongmai H Pham and Gloria J Bazzoli. 2004. "The Growth of Single Specialty Medical Groups." Health Affairs 23(2):82-90.
- Casalino, Lawrence P. 2005. "Disease Management and the Organization of Physician Practice." Journal of the American Medical Association 293(4):485-488.
- Casalino, Lawrence P. 2006. "The Federal Trade Commission, Clinical Integration, and the Organization of Physician Practice." Journal of Health Politics, Policy and Law 31(3):569-586.
- Casalino Lawrence P. “Which Type of Medical Group Provides Higher-Quality Care?” Editorial in the Annals of Internal Medicine. 2006;145(11):860-861.
- Casalino, Lawrence P, G Caleb Alexander, Lei Jin and R Tamara Konetzka. 2007. "General Internists' Views on Pay-for-Performance and Public Reporting of Quality Scores: A National Survey." Health Affairs 26(2):492-499.
- Casalino, Lawrence P, Arthur Elster, Andy Eisenberg, Evelyn Lewis, John Montgomery, and Diana Ramos. “Will Pay-for-Performance and Quality Reporting Affect Health Care Disparities?” Health Affairs. 2007; 26(3):w405-w414.
- Chien, Alyna T, Marshall H Chin, Andrew M Davis, and Lawrence P Casalino. “Pay-for-Performance, Public Reporting, and Racial Disparities in Health Care: How Are Programs Being Designed?” Medical Care Research and Review, 2007; 64(5):283S-304S.
- Shortell, Stephen M and Lawrence P Casalino. 2008. "Healthcare Reform Requires Accountable Care Systems." Journal of the American Medical Association 300(1): 95-97.
- Casalino, Lawrence P, Elizabeth A November, Robert A Berenson and Hongmai H Pham. 2008. "Hospital-Physician Relations: Two Tracks and the Decline of the Voluntary Medical Staff Model.” Health Affairs. 2008; 27(5):1305-14.
- Rittenhouse, Diane R, Lawrence P Casalino, Robin R Gillies, Stephen M Shortell and Bernard Lau. 2008. "Measuring the Medical Home Infrastructure in Large Medical Groups." Health Affairs. 2008; 27(5):1246-58.
- Shortell, Stephen M, Robin R. Gillies, Juned Siddique, Lawrence P. Casalino, Diane R. Rittenhouse, James C. Robinson, and Rodney K. McCurdy. “Improving Chronic Illness Care: A Longitudinal Cohort Analysis of Large Physician Organizations.”(Forthcoming in Medical Care.)
- Casalino, Lawrence P. June, 2008. “Physician Self-Referral and Physician-Owned Specialty Facilities. Princeton, New Jersey. Report for the Robert Wood Johnson Foundation Synthesis Project.
- Casalino, Lawrence P. June, 2008. “Balancing Incentives: Value-Based Purchasing Opportunities in Traditional Medicare.” Report for the New America Foundation project Transforming Medicare into a Sustainable and Equitable Health Program for America’s Elderly.
- Casalino, Lawrence P, Sean Nicholson, David N. Gans, Terry Hammons, Dante Morra, Theodore G. Karrison, and Wendy Levinson. “The Cost to Physician Practices of Interactions with Health Plans.” Health Affairs. 2009;28(4):w533-543.
- Casalino, Lawrence P., Marshall H. Chin, Daniel Dunham, Rebecca Bieland, Michael Ong, David O. Meltzer, Urimala Sarkar, and Margaret McLaughlin. “How Often Do Physicians Notify Patients of Clinically Significantly Abnormal Outpatient Test Results?” Archives of Internal Medicine. 2009;169(12):1123-1129.
