1997 Annual Report
Bill Brown
 |
A special kind of peaceful absorption occurs in Bill Brown when he is cruising on his lightweight touring bicycle--a fluidity of motion and exertion that quietly pushes aside the concerns and challenges of the workday world.
The physical challenge of the next hill and the downhill wind-rush soon outdistance the weekday mental challenges with which Brown, PAMF Health Care Division Controller and a key fiscal manager, has been engaged for nearly a quarter-century.
"Bicycling is a change of pace from working at a desk all day. You can lose yourself in the peaceful surroundings," Brown says of his pedaling treks among the hills, slopes and flats of the Mid-peninsula.
He and his wife, Barbara, also a certified public accountant, usually ride together--last year they joined, just for fun, a 464-mile annual ride across Iowa, along with about 10,000 other cyclists. They're gearing up to do it again this year.
"We were in much better shape than a lot of the other riders because of the tougher hills here," Brown says. "It was fun getting ready for it. I'm in better shape than ever before in my life."
He could well say the same about the steep changes in health care administration in the past two decades of the "managed care revolution" in California. PAMF has become a stronger and more-efficient organization because of it, Brown says. "We've been doing it longer," he says.
Brown joined the Palo Alto Medical Clinic as business manager in 1975. In addition to his management duties, he has been involved in three PAMF "historical landmarks": (1) the 1980- 81 creation of PAMF as a not-for-profit organization; (2) the 1987 sale to PAMF by the Clinic physician partnership of its lands, buildings and equipment (involving a major donation of value by the physicians); and (3) the 1992 affiliation with Sutter Health, a non-profit health care network covering Northern California. The Clinic physician partnership, created in 1930, provides physician services for PAMF's Health Care Division.
Keeping up with the managed care revolution has been a welcome challenge, Brown notes.
"You need to know the industry, assess how we will be affected financially and make good choices on where we go in the future. You have to be able to step back and see if the whole picture makes sense--not look too much at individual trees but at the forest."
Brown has responded to the panorama of change in a careful, fiscally conservative manner as PAMF shifted from a fee-driven, or "fee-for-service," system to a capitated, "cost-driven" management system. Most PAMF revenue now comes from capitated health plans (which pay a fixed amount per member per month) rather than a fee-for-service structure (billing for care provided).
"We look at our business in a different way and we understand it better," Brown says. "Financially, the focus is on costs and cost control while before it was on revenue. There was no pressing incentive to analyze costs. To increase revenue, physicians would see more patients or Clinic hours would be extended--but seeing more patients doesn't bring in more money now.
"We have to improve financial performance, reduce costs and still provide superior service," Brown says. "We need to measure outcomes more effectively." Brown supervises two areas: general accounting, payroll, accounting, accounts payable), and patient accounting(business office, health plans, registration).
Brown grew up in a small community of 7,000 in Ridgefield, Conn., the second of five boys. His father died when Bill was 12, but his mother, Alice (a schoolteacher and the child of Irish immigrants), instilled in her sons the same appreciation of education that her parents gave her: She and four of her five siblings had graduated from college. Brown and his four brothers did likewise.
"I started out as a chemistry major but didn't like it," Brown recalls. A career-aptitude test rated him highest in accounting--and that sounded right. He graduated with a bachelor's degree in economics from Rutgers College in New Brunswick, N.J., then entered a graduate-school program, for both an MBA and CPA. He interned at the Arthur Andersen accounting firm in San Francisco, and after graduation was offered a job.
But the U.S. Army intervened, and Brown soon was introduced to medical finance as an administrator at an Army hospital in Pennsylvania. In 1969, he was transferred to a medical group based near Saigon, Vietnam, where he was responsible for the staffing of 13 hospitals in the southern portion of the country.
Brown then joined the health care audit team at Arthur Andersen. He also met Barbara, then a fellow accountant at the firm, but it wasn't until he joined the Palo Alto Medical Clinic that they began dating. They were married in 1977 and have two children, Kerry, 20, a student at the University of Arizona, and Derek, 19, a student at the University of Colorado.
Brown lives with his family in Menlo Park. Besides bicycling, he has many interests: He plays golf, square-dances and loves singing 1950s and Broadway tunes. He also has a large garden, where he conducts his quest for the perfect tomato.
"There's nothing like eating a fresh, home-grown tomato. There is just no comparison," Brown says. Each year he tries different varieties and fertilizing methods. Last year, he buried some fish under his plants, and produced one-pound tomatoes--but size isn't necessarily a guarantee of quality, he notes.
Brown looks back fondly at his 23-year tour with PAMF. When he first started work in Palo Alto, about 40 to 50 checks were manually prepared and signed each day. Computerization of the accounting systems had not yet begun.
Over the years his job has grown. In addition to his regular responsibilities, he now deals with financial aspects of PAMF's new campus and monitors evolving changes in the relationship between administrators and physicians under managed care. "It was a lucky fit years ago," he says with a smile. "I grew with the organization."