According to Steve Geidt -- CEO of Saddleback Memorial Medical Center, part of the MemorialCare Health System in southern California -- the move toward accountable care organizations will require new structures and cultural changes. Geidt supports setting up new hospital-physician alignments to coordinate care, but said that California health care providers could be at a disadvantage because state law bans hospitals from directly employing physicians. Instead, tax-exempt agencies can contract with physician practices to establish not-for-profit foundations that would give hospitals and physicians the opportunity to integrate care.