Q&A WITH DR. VANCE BROWN, NEW BASSETT PRESIDENT/CEO

Dr. Vance Brown, MaineHealth chief medical officer and future Bassett Healthcare president/CEO, answered these e-mailed questions from Hometown Oneonta/Freeman’s Journal editor Jim Kevlin about his decision to take the Bassett helm.

1. What was it that interested you in the Bassett CEO position specifically?

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 their physician employment model for many years after reading about this 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 has been a lot of my work here in Maine the last few years, and the work and model in your region has been of interest to me. 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. I had determined a while ago that I would like to have a leadership role in an organization like Bassett; thus when the opportunity presented itself, it was a simple decision to explore this in earnest.

2. When you visited, what impressed you about the place and confirmed your original interest?

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 very clear that there is a strong commitment to community health improvement that is very important to me as well. For an organization of Bassett’s size, this is a very ambitious agenda and 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.

3. Obviously, with the ACA and other imperatives, challenges await. What would you say are the top three facing hospitals in general and Bassett in particular?

The Affordable Care Act (Obamacare) and the changes that are taking place in healthcare delivery and financing are staggering right now. I believe that the major challenges facing all healthcare organizations are in providing access to care for a larger number of individuals, but doing so in a far more cost effective fashion than we have historically done. 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 needs 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 that 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.

4. Can you talk (write) a bit about similarities between MaineHealth and Bassett system? Salaries doctors, rural setting (outside Portland), etc. Have you been involved in a particularly successful innovation at MaineHealth that might be transferrable here?

MaineHealth and the Bassett Healthcare Network 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. Many folks don’t know this about Maine, but it is one of the most rural states in the country—well over 60% of Mainers live in

communities of less than 2,000 which is the highest percentage of any state. We have four critical access hospitals in our system. A very large percentage of physicians within our system, particularly in the smaller communities, are salaried as the economics of private practice are very difficult here 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 healthcare 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 our hospitals and healthcare providers are “sole source”, this gives us an extra set of responsibilities to make sure that we are meeting the needs of the community. This has lead to some great opportunities for learning together, and there is a lot of innovative activity going on in the state as well as within our healthcare system.

I am particularly proud of some of the outcomes we have collectively been able to achieve in improving quality. Our organization has almost a 50% statewide market share in the delivery of care and Maine is one of the top 2-3 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. I hope to bring continued emphasis on this to the

organization.

5. Growing up in small town Maine, what got you interested in medicine?Family members in medicine? A particular experience? An inspiring teacher?

While I am a Maine native, I largely grew up in a small town in Ohio and only over the last 6 years have I had the opportunity to return 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 here in Maine. They constantly have 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.

6. When you look back on your career to date, does a particular “learning experience” come to mind, something that surprised you, caused you to change your approach or view of your profession?

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.

7. Are you married? Children? Are you bringing family to town?

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. Remaining close to both sides of our family, which we will be able to do in Cooperstown, is an important priority for both of us. 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 be able to use it more now that we will be living in central New York.

8. Is there something in particular, not covered here, that you would like to communicate to your future community?

Given the organizational reputation and the good work that I have seen in my visits to Cooperstown and other parts of the network, I am really pleased and honored to have been selected to help lead Bassett and the Bassett Healthcare Network. I recognize that it is an enormous responsibility and will make every effort to help the organization succeed in its critical missions. I am sure that I have a lot to learn from everyone in the community and hope to be a good listener. Lauren and I are already very grateful for the warm welcome that we have received. I look forward to meeting you!