A Conversation With Dr. Vance Brown, President & CEO, Bassett Healthcare Network

July 1, 2014

brownDr. Vance Brown, President & CEO, Bassett Healthcare Network

What was it that interested you in Bassett?

Bassett is one of a small number of organizations that I have kept my eye on for quite some time. I have been well aware of Bassett’s physician employment model for many years and read about it again a few years ago in The New York Times. I believe that providing clinicians with a salary is an important consideration in helping them make decisions that are in the best interest of the patient rather than anyone else’s economic interests. Bassett has also done a really good job in recent years of building an integrated delivery system—in other words, lining up all the resources necessary for good patient care and a good patient experience. This was a lot of the work I was involved in at MaineHealth. When one looks nationwide, there are not many organizations that have the commitment to rural health and the structures that you see in place at Bassett. It is exciting to have the opportunity now as President and CEO to help lead the organization and shape its future.

What impressed you about Bassett in your visits prior to becoming President & CEO?

The thing that really impressed me on my visits was the commitment of the organization to the missions of patient care, teaching and training of the next generation of practitioners, and advancing the science of what we do. It is also clear that there is a strong commitment to community health improvement that is very important to me. For an organization of Bassett’s size, this is an ambitious agenda. It is easy for many organizations to get distracted from these multiple missions, but I saw continued commitment to these efforts despite strong potential distractions.

What are the similarities between Bassett and MaineHealth that serve you well now?

Bassett Healthcare Network and MaineHealth are similar in many regards, although the Bassett system is smaller than MaineHealth. Both serve a large geographic region and a largely rural population and experience some challenging weather conditions.

MaineHealth, where I was chief medical officer, has four critical access hospitals in the system. A very large percentage of physicians within the system, particularly in the smaller communities, are salaried as the economics of private practice are very difficult in Maine. Maine is also the oldest state in the country on a statistical basis so the challenges of meeting the needs of an older rural population that is aging in place are very familiar to me.

Being a state with a small population (1.3 million), almost everyone in health care in Maine knows almost everyone else. As a result, there is a lot more collaboration rather than competition, although no one is a complete stranger to this. As most of the hospitals and health care providers are “sole source”, this adds an extra set of responsibilities to make sure that the needs of the community are met. This resulted in some great learning opportunities, and innovative activity in the state as well as at MaineHealth.

I am particularly proud of some of the outcomes we collectively achieved in improving quality at MaineHealth. At the time I left, the organization had almost a 50 percent statewide market share in the delivery of care, and Maine is one of the top two-to-three states in the country for the quality of care that is delivered based upon objective criteria. This requires virtually constant efforts at improvement and a culture dedicated to continuous improvement.

What do you think the most important things are for Bassett to focus on?

Having been here a short time, I am impressed overall with the quality of our people and of our facilities. There are a lot of great things going on here. Like all health care organizations though, we need to continue to focus on quality and safety—not because we don’t already do an excellent job, but because this is the most important thing we do. When patients and their families and friends turn to us for care, I think we owe them the absolute reassurance that we are doing everything we can to make sure that they have the best outcome possible—like the old slogan says, “Quality is Job 1”.

I believe that we also have to be very mindful of how to use all of our resources as efficiently as possible. We likewise have to do what is in our control to try to use our resources wisely to be maximally cost effective. I am quite confident that we would all agree health care is expensive enough, and it is also our responsibility to control those costs. This puts strains on everyone, but particularly rural delivery systems which face challenges in terms of competition for clinical providers, financial challenges from the relatively poor reimbursement available in caring for more rural populations, and the need to scale the delivery system across a geographically distributed population in smaller settings. At some level it causes everyone to ask, “Where is this all going?” I think it is particularly difficult to bring some of these changes about while engaging in front end care. The situation is not terribly different from trying to both build and fly the airplane at the same time. It is particularly challenging to engage the providers of that care in meaningful discussions while they are so busy solving the day-to-day crises that are inherent in clinical medicine.

What got you interested in medicine?

While I am a Maine native, I largely grew up in a small town in Ohio. It was only in the last six years that I returned to Maine to live and practice. For someone from a small town who is a primary care doctor by training, I have had a somewhat different background. I did not know that I wanted to go to medical school until the close of college. I went to Stanford University in California and as an undergraduate was exposed to some of the most brilliant minds in the world of biomedical research. I was inspired by these scientists (many of them originally trained as physicians) and applied to medical school sure that I was going to do basic science research. In between college and medical school, I spent a year in the VISTA program (similar to today’s AmeriCorps) living in a rural community outside of Muskogee, Oklahoma. I saw there, for the first time, how many people in rural communities did not have access to great health care or any care at all and the sometimes dire consequences that had on their health and families. That experience stayed with me, and once I got exposed to patient care in medical school, I really wasn’t as interested in becoming a basic science researcher any longer.

I am the first medical doctor in the family, although I have three uncles on my dad’s side of the family who were veterinarians with two of them having a general practice including large animals in Maine. They constantly chided me over the years that human medicine was the easy way out. Having done some barnyard rounds with them a couple of times when I was young, I have to say that I think they were probably right.

When you look back on your career to date, does a particular "learning experience" come to mind?

Anyone who is honest with themselves and gets to the point in their career where I am realizes that they, at times, made decisions about patients which were well intentioned and seemed right, but sometimes turned out to have been wrong. Despite our best efforts, ours is still an inexact science.

This is continuously humbling and difficult to understand when the consequences of our decisions are often so significant. While circumstances and experiences where you have less than optimal outcomes are disconcerting, they are the best teachers—they teach you about yourself, your colleagues, and more importantly about what you and the organization that you work in need to do to continue to improve.

What can you tell us about your family?

I am fortunate enough to have been married to my wife Lauren for the last 29 years. She is by background a nurse practitioner and is originally from Connecticut. We have one son, who graduated from college this last spring and now lives in Nashville, Tennessee. We have had a camp in the northern Adirondacks for about 10 years that we share with my sister’s family, and we hope to be able to use it more now that we are living in Cooperstown.

What do you like to do outside of work? How are you enjoying Cooperstown so far?

Lauren and I have been warmly welcomed in the community here and are grateful to all who have made our transition a smooth one so far. I grew up in a small town and having lived in Maine for many years, am well used to the idea of towns “expanding and shrinking” pretty rapidly during the summer months. Cooperstown is clearly a very delightful place to be in the summer and I expect that the community will have a very different but special character during other seasons.

I really like almost all outdoor activities and am looking forward to getting out to do some hiking, biking, fishing, and golfing. I like to read, and enjoy music and art during those increasingly rare moments when I have “nothing to do”. I do think it is important though that we all have an opportunity to “recharge our batteries”. All of our work can be pretty stressful. I am anxious to learn how others use their time off to pursue some of their passions.

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