John Fallon, MD, MBA (Senior VP and Chief Physician Executive at Blue Cross Blue Shield of Massachusetts) spoke about his journey in the health insurance industry.
Quote: "There is no security in life... only opportunity." Mark Twain.
Worked as an primary care internist from 1976 to 1990s. In the mid 80's, physician organizations formed. Hospitals formed relationships with physicians. DRGs (here to stay) to help s understand cost drivers and opportunities. Let's walk through his journey as a practicing physician who found opportunities to get involved in medical management.
Projects: (late 80's - early 90's)
- Chest pain unit (< 24 hrs). Patients who presented with chest pain on Fri had to wait until Mon. Why not treat them on Sat?
- Breast program (same day service). Abnormal mammograms and delays in biopsies. Why not offer same-day breast biopsies?
- Overcrowding ER.
- Diversion of ambulances.
- ICUs always full.
- Utilization of owned rehab facilities
- Under DRGs
- Proposed new payment models
- PHO (North Shore Health System) - yes/no
- Merger discussion
- Partners Health Care (MGH + GWH -> add NSMC/NSHS)
- Partners Community Health Care Inc. (PCHI)
- Downstate Medical Center (SUNY)
- Brought together the CEO of Clinical Affairs, hospital, and faculty practice plan.
- Success builds on success.
- The "MBA" degree enhances potential opportunities but doesn't deliver them.
- The "win" is indispensability.
- Look for opportunities to succeed.
- Seize opportunities and solve problems.
- How you solve problems and with whom you solve them are essential.
- Should MBA programs change how they emphasize hard skills vs. soft skills? Think about who we're speaking with and always ask, "how could we do things better."
- What types of opportunities exist in politics? Would you like to go before Congress?