U.S. healthcare: a collection of fragments with Jan Oldenburg

December 16, 2020
Josie Rasberry

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For episode three of our podcast, we spoke with Jan Oldenburg. Jan is Principal at Participatory Health Consulting, and has previously held roles with Ernst & Young, Aetna, and Kaiser Permanente as well as founding roles in several consulting companies. She is a nationally recognized thought leader on consumer health information strategy and she helps organizations create and implement strategies related to digital health technology and personal health engagement. Jan has written multiple books on participatory healthcare, healthcare transformation, and digital patient engagement.

Needless to say, we were extremely excited to have her on the show to hear her expertise and passion on all things healthcare. You can listen to the whole episode here or on Spotify, Apple Podcasts, or wherever else you listen to podcasts. If you’re short on time, we’ve included a few highlights from our conversation below:

Mark Camero: I’m going to come right out with the million dollar question, why do you think it is so hard for patients to find affordable, quality healthcare in the U.S.?

Jan Oldenburg: Oh, so many things! And it is the million dollar question, right? Part of it is the fragmented nature of healthcare. In so many settings, the incentives aren’t aligned, the workflow isn’t aligned, and everybody’s serving slightly different masters with slightly different goals. The other part is that we keep trying to pretend that A. We’ve got an actual healthcare system rather than a collection of fragmentary parts. B. That it’s a rational marketplace. I’m by no means an economist, but when I say a rational marketplace I mean one where your behavior as a consumer has some impact on the price you pay. In the healthcare system there are all these intermediaries, whether it’s the pharmacy benefits manager, or your insurer, or various subsidiary arrangements, and you often don’t know what the real price of something is.

Even if you try to behave like a rational consumer, you often can’t find information about the different prices, especially in the context of your insurance coverage, and you can’t really compare prices. Even if you make what seems like the most rational decision, it actually doesn’t have much impact on how rates are set or what you’d pay the next time.

Steven Cutbirth: If we want to deliver high-value healthcare we need to provide patients with easy-to-use tools that enable them to find quality care, imaging, labs, and medications at a fair price. Why doesn’t that exist today? Why isn’t there a platform in healthcare that makes it easy for consumers to shop for the care they need?

Jan Oldenburg: I think there are a number of factors that have prevented this, and one of them certainly is that oftentimes there have been contracts in place that prohibited physicians and hospitals from revealing the terms of their contracts, even in service, to individual patients. Providers saying “I can’t tell you the price until I bill you,” is the rough equivalent of having a great meal in a restaurant and never getting the bill for it until three months later, when the taste of the food and the experience has pretty much disappeared from your mind.

I’m looking forward to the changes in the rules the ONC has come out with. Hospitals, at least as of 2021 will have to reveal the terms of all of their contracts and in 2022 health plans will too. So that’s going to help a lot because that information has simply not been accessible to a third party who needed it. I would also suggest, and I’m going out on a limb here because it’s not really my area of expertise, but I think that a lot of providers are hard-pressed to actually know what things cost them. Some of the incentives for them to get really efficient haven’t been there. Similarly it’s not entirely clear to me that insurers are really incented to try to get the best prices for consumers because they get a portion of whatever that price is.

Steven Cutbirth: How do we get back to person centered healthcare, as you call it?

Jan Oldenburg: We have to understand the goals of the person, not just the goals of the system. For example, for diabetics, we focus on “What’s their A1C score?” Well, they may not care about the A1C score, but they may care about how it makes them feel. They may care about their ability to get to church every week, which only happens if their score is lower. They may care about their ability to play with their grandchildren, or have stamina to continue to work, or whatever for them the measure is. But because we (healthcare professionals) tend to force our measures on them, they don’t have a vested interest in them. They don’t have a stake in that game, at least in the way we phrase it.

If you want to hear more from Jan, listen to the full podcast above and follow her on Twitter, email her at jan@janoldenburg.com, or check out her website.

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