Executive Spotlight—Vanderbilt's Jeff Balser on why tackling waste is healthcare panacea

Jeff Balser was among the first at Vanderbilt to earn a dual Ph.D. and an M.D., and he’s been trying to fix healthcare ever since.

Vanderbilt University Medical Center CEO Jeff Balser, M.D., Ph.D., had an unusual introduction to healthcare: delivering newspapers.

As a middle school student, he sold papers inside an Indiana hospital and, since patient stays were so much longer at that time, he got to hear patient stories.

“They actually let you go room to room. They didn’t know what infection control was, I guess,” Balser said. “I’d get to know people and sometimes they would tell me things they probably weren’t even telling their doctors and nurses.”

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Just a few years later, when his own mother passed away on one of those beds from pancreatic cancer, he found himself with his own healthcare story. He was frustrated by the fact that drugs didn’t help his mother. He was also frustrated by the lack of coordination between her caregivers. 

More about Dr. Jeff Balser

Age: 57

Family: He and his wife Melinda have three grown children, Jimmy, Jillian and Maddie, as well as two “dog children” named Muenster and Violet.

Most important part of his routine: The pace and the 24/7 nature of this leadership role really require great health and resilience and energy, and I find that a regular exercise routine makes me feel so much better.

Three words that describe his management style: Always check in.

Book he recommends: “Pillars of the Earth” by Ken Follett.

Biggest pet peeve: Lack of follow-up.

Favorite thing to do on his day off: Some combination between hiking with our dogs out in the woodsy areas of Tennessee and reading bestsellers that I don’t usually have time to read.

“One doctor didn’t know what the other doctor had done or said. Nurses would change shifts and didn’t know what the one had done before them. It just felt like the system, even to me as a teenager, was kind of broken.”

RELATED: Vanderbilt the latest health system to expand reach in drug discovery business

It ultimately drove his interest in healthcare, leading him to first study biomedical engineering and later go to medical school. Becoming among the first at Vanderbilt to earn a dual Ph.D. and an M.D., Balser said he’s been trying to fix healthcare ever since.

Here's more from our conversation:

FierceHealthcare: What was your first job in healthcare?

Jeff Balser: I was at Hopkins as a resident and was there for nine years. I did my residency training in anesthesiology and then fellowship training in ICU medicine. My niche was taking care of cardiac surgery patients in the postoperative ICU. The patients were incredibly sick because those were heady days in cardiac surgery and we were doing some of the earlier lung transplants and heart/lung transplants. Sometimes the patients were so sick, we had to have two ventilators in the room—one for each lung.

During my week in the ICU, I’d basically be there all the time. I was confronted with the fact there was a lot wrong with how we delivered care to patients with treatments that worked for some people but didn’t for others. And also, there were clunky things about the system and having the right information when you needed it.

FH: How did that impact your career?

JB: The real drive I had was to understand why some people responded one way to a certain drug and others responded a different way. It turns out at a national level, probably 50% of the time anyone takes a certain drug, it either doesn’t work or has a side effect. … That kind of work has really become my passion to really develop the systems and understand it broadly around all drugs and to then overcome the barriers we have to deliver that information to doctors and patients when they need it in real-time.

FH: Where are we now with delivering precision medicine?

JB: There’s a really funny cartoon that was in The New Yorker that came out in 2000 right around the time human DNA was first sequenced. It shows a person standing at the pharmacy counter handing the pharmacist her DNA sequence and the pharmacist just has this perplexed look on his face. You show that cartoon now and the same thing would happen and it’s been 20 years. The difference is now we actually do know for probably 100 drugs that you should have a different drug or different dose. But we’re just learning how to project that information into the healthcare system in a way that is useful.

FH: What keeps you up at night?

JB: I feel like it’s an emergency to figure out how to get the waste out of the system. We spend a lot of time talking about which insurance system would be better. There will be plenty of political debates over that over the next few years.

Honestly, the financial impact of that would be tiny relative to the amount of waste there is in the system. That has nothing to do with which insurance is involved. We really need to be much more serious about attacking the waste issue. And most of the waste is inadvertent. It’s not intentional. And it relates to inefficient communications systems.

Why is it today that a patient can come to one emergency room and if they get admitted to a different hospital, the x-rays have to be repeated or the labs have to be repeated because there’s no communication? There’s that kind of waste and then there’s also a huge amount of waste related to drug therapy. There are a lot of situations where chemotherapy is administered to patients where we know that at least 80% will not respond.

FH: You led the spinout of Vanderbilt University Medical Center from Vanderbilt University. What were some lessons you learned from that process?

JB: Universities tend to run with very high bond ratings because they tend to have stable financial and large endowments. They benefit from having very inexpensive debt. Medical Centers tend not to have ultrahigh bond ratings. We were eating up their debt capacity and they were eating up ours and we were kind of stuck.

The university looked at that and said, "Listen, we want the medical center to be wildly successful because the medical center is actually the home for training an enormous number of Ph.D. students and medical residents. And so we want to unleash the medical center’s capacity to grow and access the financial market. "That was the rationale for the separation.

It wasn’t to pull us apart academically, and one thing the chancellor and I have worked very hard on over the last five years is to make sure we maintain those tight connections around the research and the educational enterprise. It’s one of the reasons I am still the dean of the medical school, which still lives in the university. All the doctors at the medical center are still Vanderbilt faculty for that very reason. It was a reorganization for financial reasons. People ask, "Did it work?" I say, "All you have to do is to come to campus and you’ll see cranes on one side of campus putting up new beautiful student housing and on the other side there are cranes because we’re expanding our children’s hospital."

FH: What’s next?

JB: I would like to see us do some of the exciting things I’ve described in genomics at larger scale throughout the southeastern region, and using health IT to provide more seamless care. … I would love to see the genomic work we’re doing on campus also begin to move into the region so that we can help people really have only the best therapies and the right therapies they need.

The NIH awarded us the data and research centers for the All of Us program, and those are here on campus. I’m excited about learning more about the analytics of how to extract information from the health record and the DNA and make it as useful at informing us about care for the patient and using the VHAN to deliver that to the point of care. That’s what keeps me up at night in a good way.

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