MD/MBA Careers: Commercial Payors

Highlights from the Association of MD/MBA Programs (AMMP) 8th Annual Conference.

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.

How do you solve these types of problems? Discuss the need, evaluate options, and implement solutions. Bring people together and facilitate discussion.

Early 90's

• Utilization of owned rehab facilities
• Under DRGs
• Proposed new payment models
• PHO (North Shore Health System) - yes/no
• Rationale

Early-mid 90's

• Merger discussion

Mid-late 90's

• Partners Health Care (MGH + GWH -> add NSMC/NSHS)
• Partners Community Health Care Inc. (PCHI)

2000's

• Downstate Medical Center (SUNY)
• Brought together the CEO of Clinical Affairs, hospital, and faculty practice plan.

Now, we're in a brand new situation. Healthcare reform will occur at local and national levels.

Closing comments:

• 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.

Questions:

• 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?

Make sure to return in a few weeks to find a hyperlink to Dr. Fallon's slide presentation.