Rewire Type A personality for capitation success
Rewire Type A personality for capitation success
The Type A personality that has gotten many of us where we are today is not designed for success under capitation. There are ways to reform without entering a 12-step program, and it involves, in essence, a simple shift in pronouns - moving from an "I" mentality to a "we" mentality. I like to call it "capitation through collaboration."
Collaboration is not something that is necessarily taught during medical school and residency. Students and residents are rewarded more for their achievements as individuals rather than as members of teams. Individual performance on exams and in clinical rotations brings recognition and rewards of prestigious residencies, slots as chief residents, or highly sought fellowships.
But this individual-performance mentality can jeopardize an individual's chance of success in the real world of patient care, which rewards providers who offer a model of seamless delivery of patient care. This seamless delivery of care enables a patient to move smoothly from care received in a physician's office to services delivered in hospital, home health, or other allied health settings.
Isolated silos of capitation where the hospital, primary care physician, and specialty physician are all individually at risk can promote disparate care and even patient dumping. Fortunately, HMOs and especially IPAs that accept global risk are getting away from this and moving toward a model that promotes collaboration rather than competition.
The power of collaboration derives from having each partner contribute what it does best or more efficiently. Thus, the collaborative data provided give the highest return to the patient care delivery process.
Moving from an individual to a collaborative process is indeed a major paradigm shift for many engaged in medical care. Yes, there it is again, that ugly and overused word - paradigm. But here it is necessary to use the word "para digm" because that is what describes the situation. This is a para digm shift that challenges the individual identity of a generalist, a specialist, or an ancillary care provider.
Collaboration requires all health care providers to understand each other's perspectives and to appreciate how their expertise and attributes relate to and reinforce each other. It entails a willingness to work with other health care providers whose contributions do not compete but rather complement their own.
Consider the following example: A patient comes in with an acute onset of low back pain. It appears to be entirely muscular in nature with no neurologic signs.
A primary care physician generally would treat such a patient with rest, an anti-inflammatory medication, and possibly a muscle relaxant. A chiropractor, on the other hand, might treat the patient with manipulation and massage. Studies have shown that such chiropractic interventions can reduce the length of time that a patient is symptomatic, as well as reducing the overall cost of treatment for some episodes of low back pain.
Does this mean the chiropractor releases the physician's care? In a competitive model, the physician might think so and thus be fearful of referring the patient to the chiropractor. In the collaborative model, however, both care providers realize that by working together, they can deliver the best, most efficient care to their patient.
Furthermore, if the physician and chiropractor are both at risk for the patient's care, and both benefit if costs are down and quality is up, the collaborative model will help them realize these financial gains much sooner than the competitive model will. The collaborative model requires that the patient be sent to the most appropriate medical caregiver at the most appropriate time and at the most appropriate site.
To do this requires all caregivers to re-examine their contributions and roles as they relate to caring for patients. It means seeing themselves not as separate entities or enterprises, but as part of a larger, common health system. It means relinquishing the "do-it-all-yourself" mentality and becoming more open to the notion of support. The common goal of maximizing health and minimizing disease, disability, and suffering unites all of us as health care professionals. It should further unite us in the collaborative model of health care delivery.
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