When Robert Vest earned his law degree from the University of Tennessee, his plan was to pursue a career in community service in his hometown of Lenoir City, a Knoxville suburb. Serving as Chief Operating Officer of the Baptist Medical Group (BMG) in Memphis was beyond imagination.
Fate, however, in the form of a fellow law student from Memphis and his future wife, guided his attention toward her hometown, which she considered a great place to live and raise a family.
His successful handling of a high-profile first-amendment case during his first year in a Loudon County legal firm led to additional litigation opportunities, Vest recalls-but his new family's move to Memphis "reminded me that this isn't necessarily what I wanted to do."
When the position with Baptist opened in 2008, Vest shifted gears and took on the job of helping hospital administrators and corporate leaders negotiate and execute physician services agreements for the BMG. His experience as a transactional attorney was helpful, but his inexperience and fresh perspective also proved to be an advantage.
He took on the new role of executive director of physician acquisitions and development in 2010, building on an original population of about 40 employed providers which grew to over 500 within four years. As the Baptist representative who met with doctors and negotiated both independent and group practice acquisition agreements, he developed trusting relationships with many of the physicians--and a personal obligation to fulfill promises made.
The new hands-on role and additional responsibilities of executive director of transition operations enabled Vest to help newly acquired clinics transition smoothly and correctly into the BMG culture--sometimes by operating those clinics for a year or more.
He takes pride in having developed an infrastructure that has allowed BMG to create a group culture that empowers physicians to do more together to improve patient care than had been possible separately.
"We're the first generation of Baptist Medical Group; it's very rare that one has the opportunity to be an architect of something new--particularly in an organization like Baptist, where you're well-funded and you have the resources to do wonderful and great things...I want to make sure that this Group outlives us."
He points to BMG's Diabetes Care Coordination Implementation Team (DCCIT), conceived and implemented through the brainstorming efforts of concerned physicians seeking an affordable way to better treat diabetic patients.
"If we can get these patients to come back every 90 days for their appointment, we could make sure they understood their medications, that they could afford them and were taking them...and we could get them into diabetes education to help them better understand their disease and be more proactive in their own care."
Vest said that in mid-September, after making its 47,000th phone call to a group of 5,000 patients, the DCCIT has outperformed well-known national programs, demonstrably reducing patients' A1C by about 1.86 points, extending their lives by more than seven years, extending their vision, saving them an estimated $7,000 in medical expenses, and making their lives better.
They plan to use the same affordable model to provide lung cancer screenings for BMG's smoking patients and address other chronic care conditions.
Although BMG currently has more than 800 physicians, and the group's turnover is significantly below national averages, burnout is nonetheless a concern.
"Physicians are under a lot of strain in this community because the need is so great, and they're so few," he points out, noting that most of BMG's physicians work 14 to 16-hour days. "-- because they care about their patients," he stresses.
Electronic health records and evolving technology also add stress and steal physicians' time. Vest has addressed the burnout problem at national conferences where it is a growing concern. "I see my role--and my team's role--as eliminating obstacles in the way of physicians being able to deliver patient-centered care."
Although the trend toward practice acquisitions has slowed, Vest observes that there are still more than 100 open recruiting positions for new doctors across the Baptist system, especially in the rural markets which have long been underserved.
As BMG moves toward a patient-centered medical home model, primary care physicians, who are in increasingly short supply, are especially needed. That many providers are over 60, and currently caring for "a not insignificant number of patients" is also worrisome, he notes.
Patient expectations are also evolving, prompting BMG to innovate and implement more convenient ways to see a physician, e.g. hybrid clinics that combine a walk-in clinic with traditional primary care, evisits, and televisits--which are a challenge "because payors haven't...developed a methodology for paying for those yet, in traditional plans."
Today, Vest's legal roots still impact BMG's success by influencing his management style. "My legal training at UT was very Socratic; you answer questions by asking questions. I apply that concept to every decision I make, and I've tried to pass it on to my team. We question why things are occurring--even positive things...to make sure we see both sides of an issue and we're making the best decisions."
When both his parents faced life-threatening diseases, he realized how helpless even a strong-willed problem-solver is.
"It really gave me a perspective - and I hope I bring that leadership perspective to my team - of putting yourself in the patient's shoes, recognizing that every person a patient touches in our organization contributes to that patient's quality of care."
It appears to be working: On that date in 2010, he notes, "our patient satisfaction was at the 27th percentile; and last quarter, it was at the 81st percentile."
His pride in his team is clear; but Vest believes his greatest life accomplishment may have been convincing his wife, Courtney, to marry him--and make possible two other great accomplishments - his sons Anderson, 8; and George, 4.
"Jesus told us that the second greatest commandment is to love your neighbor as yourself. In healthcare, maybe more than any other industry, we have the ability to actually communicate that love and caring to the people of our community who really need it . . . regardless of shade, age, sexual orientation - it doesn't matter. We're a community in healthcare.
"That's a little unique; and if my sons choose to go into that field, I'll be very proud."