Physician organizations. Part 1: A report from the trenches of a start-up PO

How has Community Health Partners, a physician organization based in Kansas City, turned the corner as it rolls into the second year of operation? The biggest indicator is that CHP hammered out the city's first professional risk contracts and the PO has grown from 23 to more than 50 physician member/owners. Looking back, there are at least 10 reasons why CHP made it this far. These are not reasons you learn about in medical school or an MBA program. There is no one-size-fits-all template for building POs. No fixed organizational chart. No neon signs pointing to the best capital partner. Part I explores five reasons for success, such as having a strong board and physician leadership, as well as educating participating physicians about capitation and affiliating with any hospital or payer that really knows how to partner with physicians. Part 2 will focus on five more lessons learned from the trenches of a start up PO.     

Coming out

Self-knowledge is the beginning of integrity, of coming out of the closet, and is a prerequisite for dealing well with change. Integrity is not just about not lying. Integrity means as on the inside, so on the outside. The Latin roots of integrity refer to touch. To have integrity is to be untouched, undivided, whole, integrated, integral. There is a tight relationship between integrity and the ability to change, because integrity is about knowing yourself, about being transparent. Integrity allows you to move with tremendous speed when the time comes to move. An organization that wants to learn to dance with change must come to know itself and its environment thoroughly. To do this, it must make use of all the knowledge of every member--and all of their learning capability. It must be built into the culture that new information and different points of view are powerful, are welcomed.     

Health care futures. Part 2: The future of physician executives? Panel discussion

What is the future of health care in America? This is Part 2 of The Physician Executive panel discussion that explores the future of health care in America. To narrow this ambitious focus somewhat, the future is defined as five to 10 years hence. In Part 1, which was published in the May/June issue, Russell C. Coile, Jr., Barbara LeTourneau, MD, MBA, FACPE, James Reinertsen, MD, Uwe Reinhardt, PhD, Marshall Ruffin, MD, MPH, MBA, FACPE, and David Vogel, MS, shared their opinions about what the future holds in managed care, information technology, and biotechnology. In Part 2, Susan Cejka, Barbara LeTourneau, MD, MBA, FACPE, John Henry Pfifferling, PhD, Uwe Reinhardt, PhD, and James Todd, MD, share their views on the future of medical education and physician executives.     

Where can we learn about change?

Presented here are some resources--books, consultants, and personal growth practices--that you might find useful in the struggle to become adept at dealing with change. Mastering change is a long process, but unlike building a cathedral or growing apples, as soon as you start you will have something that you can use--some insight, a different way of looking at what is confronting you, something to help jar you to a more creative strategy.     

Medical savings accounts. Power and choice

As the market becomes more saturated and matures, keeping people healthy will become a bigger source of profits and true health maintenance will become increasingly important. Right now, however, the name of the game is restricting services, particularly in new markets. What is sorely needed is a balance between the individual and organizational agendas, between the individual and society. There is a tremendous opportunity for hospital-physician groups contracting directly with employers using Medical Savings Accounts (MSAs) and catastrophic insurance as a core strategy. Are MSAs a viable insurance vehicle? Some argue that those enrolled in MSAs will put off receiving needed medical care. But it can also be viewed that MSAs, by their very nature, put costs back into the negotiation phase between patients as customers and physicians and hospitals as providers--and save money and resource consumption as patients shop around for competitive prices to do what needs to be done.     

Running toward the roar

How do you embrace paradox, changing and growing without losing your sense of who you are? We talked last time about the paradox of reaching for the new, without losing your ground in the old. Paradox is the place of insight. Accepting paradox, not as a momentary distraction but as a place to live, lies at the heart of dealing successfully with change. We can see this most clearly if we ask ourselves, "What business am I in? What am I about?" In health care, this did not used to be a meaningful question. Today, it is a critical one. But to really develop, we have to seek out the situations that are the most difficult for us, work them through, hang out with them long enough to begin to be at home in the paradoxical, ambiguous, and strange circumstance.     

Mixed estimation of old-age mortality

"Section 2 will first extend the method of mixed estimation to maximum likelihood estimation in general. Then, we will review generalized linear models with logistic and Poisson regressions as examples. In Section 3 we discuss different approaches for formulating the auxiliary information in practice. Section 4 first reviews the method of Coale and Kisker, provides empirical estimates for it, and then proceeds with the mixed estimation variant. In Section 5 we apply the methods to the estimation of mortality at ages 80+ in Finland in 1980-1993. We will first consider the evidence for mortality crossover between males and females....Then we will estimate life expectancies at age 100." (EXCERPT)     

Second generation decline? Children of immigrants,past and present--a reconsideration

"Is the contemporary second generation on the road to the upward mobility and assimilation that in retrospect characterized the second generation of earlier immigrations? Or are the American economic context and the racial origins of today's immigration likely to result in a much less favorable future for the contemporary second generation? While several recent papers have argued for the latter position, we suspect they are too pessimistic. We briefly review the second generation upward mobility in the past and then turn to the crucial comparisons between past and present."