Better Than Rocket Science

Jim Hester applies engineering skills to social systems

by Julia Lynam

In 1997, Jim Hester arrived in Vermont to take the job of vice president of MVP Health Care with offices in Williston. Although he left behind his work in astronautical engineering, Hester continues to apply the tools of his earlier profession to his work in health care and education.

Nothing in Jim Hester's immaculate office is without meaning: A huge brass rubbing of his wife's English ancestors' grave dominates one wall; opposite hangs an intricate quilt sewed by his grandmother; a photograph of his daughter conceals a complete set of photos taken of her on each of her 16 birthdays; "and this," he says, displaying a chunk of clear plastic pierced by two narrow holes carved by a laser beam, "is a relic of my last job before I moved out of engineering."

Hester, who came to Vermont in 1997 to take up his role as vice president of MVP Health Care, earned two degrees in aeronautics and astronautics from MIT, and spent a summer working on NASA's Apollo lunar-escape module rocket engine before changing course and switching to urban studies at MIT for his Ph.D.

"I loved the engineering training and applying the tools," he recalls, "but the last work that I did in engineering was on very high-powered laser weapons systems. I wanted to move away from weapons and apply my skills to other fields, so I began applying engineering approaches to social problems, initially working in housing policy, then health care, for the city of New York."

In 1974 Hester joined Kaiser Permanente, one of the early pioneers of the health maintenance organization concept, in Los Angeles, returning to Boston to become senior vice president of the New England Medical Center in 1979.

His progress has included research and teaching appointments at his alma mater and other universities he is currently an adjunct assistant professor at the UVM College of Medicine as well as stints as vice president for large health insurance companies in Massachusetts and Ohio. At MVP Health Care, Hester is responsible for the company's growth and operation in Vermont: he oversaw the statewide expansion of MVP membership from 10,000 in 1997 to 75,000 in 2000, while converting a $1 million loss to a $2 million surplus.

"He's a great person to have in the state," says Tom Huebner, a longtime friend and associate, and president and CEO of Rutland Regional Medical Center. "He's an extremely smart and articulate guy who has a way of thinking about health care and its design as an entire system. He makes suggestions of ways to improve that design, and he challenges people without getting their backs up. He's a community leader in the best sense of the word."

MVP Health Plan is a division of Schenectady-based MVP Health Care, which also includes the for-profit subsidiary companies MVP Health Insurance Co. and MVP Select Care Inc. Lou McLaren (left) is regional director for provider networks; Joyce Gallimore is director of quality improvement and care management; and Bettie Bransfield is marketing manager.

MVP Health Plan, the company that lured this formidable thinker to Vermont, is an independent not-for-profit corporation offering community health insurance plans in New York state and Vermont. It is a division of Schenectady-based MVP Health Care, of which Hester is vice president. MVP Health Care also includes the for-profit subsidiary companies MVP Health Insurance Co. and MVP Select Care Inc.

The parent company grew out of the work of a group of physicians and community leaders who, in 1980, laid the framework for what was then an innovative approach to health care: a health maintenance organization or HMO. The Mohawk Valley Physicians' (MVP) Health Plan began operating in 1983 in two New York counties. It rapidly spread to other parts of the state and, in 1995, moved into Vermont, becoming the largest managed care organization in the Green Mountain State.

It might not be rocket science, but attempts to unravel the complexities of the health care system in this country may very well benefit from a mind with capacities developed by the study of astronautical engineering. Hester brings the analytical mind of a systems engineer to the challenge of redesigning the health care system to serve people better and more economically.

One challenge Hester encountered in switching from pure engineering to health care was in learning how to combine his initial skill set with the art of dealing with people: "We're exploring how to change behavior in a constructive way," he says. "For example, we created financial incentives to reward physician performance. The analytical piece was figuring out meaningful and reliable measures of physician performance in Vermont, and how to capture that data in a credible way; and we needed to involve the physicians in choosing and implementing these measures, so the process also took into account the need to communicate. If you're trying to change behavior, you have to do it in a fair way.

"The heart of the issue is that the health care system in this country evolved to deal with acute problems and infectious diseases," he explains. "It was designed for the situation in which a sick person goes to the doctor who gives them something to make them better. But two-thirds of the money spent today had to do with chronic illnesses requiring long-term behavior change by the patient to deal with such issues as diet. The system needs to be redesigned as needs evolve."

Hester is not alone in this vision of change in Vermont's health care system; he belongs to the newly formed Coalition 21, a participant organization of business groups, insurance companies, hospitals and medical societies that have agreed "to leave our guns at the door and develop some consensus to deliver to the Legislature," according to Lisa Ventriss, executive director of the Vermont Business Round Table.

She's impressed by Hester's approach. "When I think of Jim Hester I think of one of the small number of business leaders who walk the walk and talk the talk," Ventriss says. "If he says he'll participate he's in 100 percent. He helped the Round Table formulate our principles on health care reform, and he did it in a way that forced him to put his own worldview aside. He sees the big picture, understands complex design issues, is willing to play a leadership role and makes a huge investment in the community."

Jim Hester is responsible for MVP Health Care's growth and operation in Vermont, having overseen the organization's statewide expansion from 10,000 in 1997 to 75,000 in 2000, while converting a $1 million loss to a $2 million surplus. Pictured: Gay Godfrey (left) and Lisa Cox, utilization review nurses.

In his work with Coalition 21, Hester recognizes three important challenges facing the health care system in Vermont: providing health insurance to every Vermonter; finding the most effective way to finance that coverage; and ensuring that health care and health insurance are affordable and remain that way.

He says he is a strong proponent of choice even when it adds expense to the system. "Competition is a very important force," he says. "Something might be appropriate this year but not next, so we need a structure that responds to change. I believe that a pluralistic approach with multiple choices will be best in the long run. It may be attractive to have a single provider, but it's hard for a system like that to perform well over time.

"The rate of increase of health care costs is higher than the overall economy because of the demographics of an aging population and because advances in technology continually make new treatments available. We need to close the gap between the rate of increase in health care costs and the economy in general.

"We have an opportunity to both reduce costs and improve care. For instance, according to the Institute for Healthcare Improvement, there are many preventable errors in clinical care. They have identified five ways to reduce errors between now and 2006, which, if adopted by hospitals throughout the country, could save 100,000 lives."

A belief in the value of focused education has led Hester to become involved in an attempt to reform the secondary education system in Vermont. "A few years ago I started getting very interested in high school education in the lack of competitiveness of math and science education in this country and I became concerned about the performance of our high school math and science programs

"I joined the work-force investment board of the Lake Champlain Chamber of Commerce. They were publishing the results of the first three years of study of technical education in Vermont and they got me hooked. I realized that there was a major segment of the student population whose needs are not being met by traditional college preparatory courses or our existing 40-year-old technical education system."

Hester became chairman of the board of the Vermont Technical Academy school district, promoting a project for a combined technical academy in Chittenden County that has since foundered. "I feel disappointed that a major opportunity has been missed," he says. " Even if something new does emerge from the ashes, it will be three, four or five years longer before students see any benefit. Right now we're in the process of asking what constructive role the board can still play in improving technical education in the county."

When a technical academy does open, Hester will be ready. He earned his master of education from St. Michael's College last year. "I've had a strong interest in secondary education for a number of years now," he says, laughing, "taking individual courses. I said, 'I'll just go ahead and put it together in getting a master's degree.'"

Hester says his interest in secondary education was largely stimulated by the experiences of his own children. He and his wife, Sarah Bartlett, have raised five children, two of whom still live at home. "My extended family is very important to me," he says. "We have regular family get-togethers of five generations of my father's mother's family on their 10 acres in the Texas panhandle."

His own childhood experiences as the oldest of eight siblings with a U.S. Air Force officer father left a permanent legacy. "We lived all over the place, including Libya and Ecuador," he says. "That process of moving regularly and seeing how different communities in different countries approach issues was an important formative experience in terms of how I handle change." •

Originally published in March 2005 Business People-Vermont