While many people may go their whole lives without being admitted to the hospital, there are some patients who are admitted repeatedly—sometimes in the same month. Over the course of working at two different hospital systems in different states, Francis Balucan, MD, MBA’16, observed the prevalence of these repeat patients. An internal medicine physician, Dr. Balucan began looking into why those patients returned, and he realized the reason is something not often measured by hospitals where he worked.
“The population I’m treating has a lot of these intersections of social determinants of health: where they live, if they have access to affordable housing and grocery stores, among others,” says Dr. Balucan. “The bigger question from a physician standpoint is: What role do we play in that?”
With so much behavior impacted by social determinants of health, healthcare officials increasingly consider how these factors affect a wide range of health and quality-of-life outcomes. Dr. Balucan realized no one was capturing this information on the patients repeatedly admitted to his hospital. Having recently completed the Physician MBA Program at the Kelley School of Business, he applied his newly acquired business skills to launch the Vanderbilt Familiar Faces Program at Vanderbilt University Medical Center in Nashville, Tennessee.
“Some of these patients are uninsured or underinsured. Vanderbilt is a very busy hospital — if we could take care of these patients outside of the hospitals, it’s a win for the patients to avoid expensive hospital bills, a win for the hospital to have an open bed for a sicker patient and a win for an insurance company that doesn’t pay for hospitalization,” says Dr. Balucan. “It’s really a win-win-win scenario, but no one approached this idea before because no one knew how to break down those different buckets of risk for each stakeholder.”
Dr. Balucan launched the pilot program for high-need, high-care patients in 2018.
“When I got here, Vanderbilt had a better way of handling this issue than many hospitals, but they didn’t have the structure of a program,” he says. “With my colleagues, I created the program that fits the vision for this population, and I sold that idea to the medical center and the insurers, telling them they had to sustain it. I used all facets of the MBA to do this, especially the negotiations and communication skills.”
I used all facets of the MBA to do this, especially the negotiations and communication skills.”
In the past three years, Dr. Balucan and his colleagues achieved a 41% decrease in admissions and 38% decrease in ED visits among patients in the Vanderbilt Familiar Faces Program.
In this work, Dr. Balucan leads conversations with insurance providers, care teams and hospital administrators to find a productive, middle ground. He leads the program with seven physicians, a case manager, a social worker, a pharmacist and a program coordinator, all working to solve this common hospital issue. Being a physician leader means speaking to all those audiences’ needs and concerns and compromising toward a solution.
“I’m in those rooms with insurance contractors and all these non-clinical people, and I could see the frustrations from both sides — from the administration to the clinical staff. They couldn’t find a way to merge their languages to get un-stuck from status quo,” says Dr. Balucan. “The Kelley Physician MBA allowed me not only to understand the clinical risk, but also the organizational and financial risk. I could see it more holistically. If I can talk about finance to make this more comfortable for the finance people, there’s a middle ground. I’ve been successful in that middle ground because I could bridge that language.”
If I can talk about finance to make this more comfortable for the finance people, there’s a middle ground. I’ve been successful in that middle ground because I could bridge that language.”
Like many physicians who enroll in the Physician MBA Program, Dr. Balucan could recognize large problems in healthcare, but he didn’t know how to fix them. Physicians like this seek business knowledge to be able to bridge conversations like the ones Dr. Balucan has with care teams, administrators and insurance professionals. He quickly became medical director of the program by age 38.
“Having the MBA credentials hastened my ascent to this position because I was able to navigate things better and faster, and I get things done easier,” he says. “Typically, when you start in a new system, it takes time to understand how you get things done. I hit the ground running — I got more successes quicker, and people noticed.”
The courses on entrepreneurship, leadership and process improvement helped Dr. Balucan see the same old healthcare problems — and his role as a physician leader — differently. He gained wider perspective and a more collaborative, team approach to problem solving.
“I’ve realized my role is not to be the loudest person in the room but the one who gets people talking to gain buy-in and input on a plan. I better understand my privilege in the healthcare system and what my role should be. Rather than preserving my physician privilege, I can give that space to others to speak up on their thoughts. It really gets programs moving,” says Dr. Balucan.
“I used to be adamant on certain ways I wanted to do things, and I wouldn’t budge. I’ve now learned that once you let go magical things happen because you get other people involved. I get to do less the more I let go, and everyone’s happier. My whole life I’ve been controlling a plan for the best outcome, but the Kelley Physician MBA taught me that learning to let go gives you the best outcomes for the whole.”
My whole life I’ve been controlling a plan for the best outcome, but the Kelley Physician MBA taught me that learning to let go gives you the best outcomes for the whole.”
Dr. Balucan participated in the Healthcare Policy Experience course at Kelley that took physicians on an immersive to Washington, D.C., to learn how healthcare policy is developed and how the average physician can have a voice in change. Dr. Balucan says the course not only put into focus how his organization responds to policy, but also gave him a way to see change coming and react proactively for hospital leadership.
“Our team handles a lot of alternative payment models, and every time I send the latest information to leadership they’re very appreciative because this is the future of healthcare,” he says. “Leadership knows what’s coming, and they’re making micro changes that we may not see down in patient care — we’re just responding to the prevailing winds. Now, I’m more proactive. I know what’s coming and how we should respond. The course taught me policy language and how to use it.”
As someone in the early stages of his career, Dr. Balucan appreciates having experienced a physician-only MBA program in which he became close friends with other doctors from various specialties and career stages. He now has longtime, personal contacts across the country.
“If you’re someone who’s dissatisfied with the status quo and looking for the language to advocate for change, the Kelley Physician MBA Program is the best place to get comfortable understanding how it’s done,” he says. “You’ll meet other, like-minded physicians advocating for change and gain the tools and skills to advocate for that change in your own field.”
If you’re someone who’s dissatisfied with the status quo and looking for the language to advocate for change, the Kelley Physician MBA Program is the best place to get comfortable understanding how it’s done,”
Ultimately, Dr. Balucan says the greatest return on his investment in the Physician MBA Program is how it helped him recognize his full potential and what his vision could be for healthcare. He leads his program armed with a solid vision for what he thinks healthcare can — and will — be.
“Not every physician wants to get involved in social determinants of health, but for me, that’s who I am and what I believe in,” he says. “The Physician MBA allowed me to express myself fully and realize my full potential while also influencing other people on my vision for healthcare. It’s fulfilling to talk and grow with people who listen and support you with resources because they believe in it, too.”