Introduction and Episode Context
[00:00:02] Stacey Richter: Episode 483, Bonus Clip. Let's make sure we are honoring those who work inside large healthcare organizations who are trying desperately every day to do the right thing.
This is a clip from my conversation today with Jonathan Baran.
To listen to this episode or read the show notes which include the mentioned links, visit the episode page.
Highlighting Healthcare Workers' Efforts
[00:00:33] Stacey Richter: Okay. This clip, you could call it a reel, I guess, because kids these days, but I think it is a really important four or five minutes or whatever, because it's my guest on the pod this week, Jonathan Baran, and next week, actually.
And Jonathan Baran makes a very important point, and this also comes up, by the way, in the show with Dr. Jon Lee a from a couple of weeks ago. Large, consolidated health systems, large vertically integrated carriers, and their PBMs and their GPOs in Switzerland or Ireland or whatever, and some of these large benefit consulting firms. The hundreds of thousands of folks who work in these places, some of them for sure are on board for the ride who don't really care about their ultimate impact that they are having on patients, members, or the non-healthcare economy in the United States. That's probably true.
It's also probably true that the majority don't actually understand what's going on and the impact of their actions. But there definitely is a cohort, there's a gang in there, and many of this gang listen to the show, and these folks are trying desperately against every personal incentive against lashback, against all odds.
They're trying to figure out how to get their organization to do a little bit better for patients or members or plan sponsors, actually, if we're talking about anybody who works at some of these large benefit consulting firms.
We are not one with the stakeholder that we work with, and if the object is to do better by members and patients, it's really incumbent on us to understand what is going on in our very own neck of the woods. We can't improve if we don't really understand what the problem is.
So the conversation that follows is Jonathan Baran offering up a plea. Really, on behalf of these folks our knights, if you will, to please not generalize the intentions and values of everyone who works somewhere and assume that when a C-suite embarks on some margin focused endeavor, that everybody who works at that place is in full agreement with that path.
That's kind of like throwing babies out with bath water territory, and ultimately we need as many on our side as we can get. I actually did a whole show on this called "The Narcissism of Small Differences”. If you're so inclined, please do go back and listen to it. Also, listen to the show with Larry Bauer. It was a summer short from a couple of years ago called “Knights knaves and Pawns".
My guest for this short segment is Jonathan Baran. He has always been a healthcare entrepreneur. Today he is co-founder and CEO of Self Fund Health, which is committed to challenging the expensive healthcare system in Wisconsin.
This episode is sponsored by Self Fund Health, and my name is Stacey Richter.
Jonathan Baran, welcome to Relentless Health Value.
[00:03:09] Jonathan Baran: Stacey, thank you for having me today.
[00:03:11] Stacey Richter: So before we get started talking about a topic, I am so looking forward to talking about, do you wanna just give a brief background?
[00:03:19] Jonathan Baran: Yeah, absolutely.
The Importance of Understanding Healthcare Systems
[00:03:20] Jonathan Baran: And really truly, it is an honor to be here today because your podcast is one I've listened to over the years, and it has been one of the single best resources for actually understanding what is going on in this healthcare ecosystem.
And one of the interesting things that really led me to your podcast is, I really could not answer some of these questions like how healthcare worked. How did it get financed? Why is it so expensive?
It feels like one of the single biggest reasons that nothing changes in healthcare is because all of the stakeholders actually don't really have a good understanding of how the whole system functions. So this is everything from employers to providers, to brokers, to politicians, to executives.
Incentives and Behaviors in Healthcare
[00:03:59] Jonathan Baran: And so my goal today is to hopefully shed a little light on this because there's this famous Charlie Munger quote, "Show me the incentives and I'll show you the behavior". And my goal today is to talk about the incentives and then how this ultimately explains the behavior.
I'm not attacking individuals, I'm calling out the actions that are being driven by the incentive structure that's in place.
Addressing Stakeholder Misconceptions
[00:04:23] Stacey Richter: Thank you for the lovely compliment. The one thing that is probably a foundational imperative as we go about conceiving of and thinking about how anybody is going to, I was gonna say transform, I kind of mean just improve at any level, the healthcare system is that we as individuals stop identifying with the stakeholder that we work with in this kind of a hundred percent overlapping Venn diagram sort of way.
Because if anytime anyone says something, which may be, slightly less than neutral about the stakeholder where any of we individuals work with, we need to make sure that we understand that this is not a direct attack on us.
It is a comment on what the incentives are for the part of the industry that we work with or for. And unless you know, you don't wanna be a solution looking around for a problem. So step one in any sort of solutioning is to figure out what the problems are and if everyone kind of takes offense at, and I don't want need to belabor this point, but I think it's kind of inherent in what you're saying, that there are incentives and we really need to understand what they are because if we don't understand what they are, then we can't figure out how to address probably some of the things that we may be contributing to or a victim of.
[00:05:47] Jonathan Baran: 100%. And that's my goal with this, is to be direct. Because it's also to, I feel like we, we have this challenge in healthcare where we oftentimes speak in platitudes and we always, we, we can't get to the actual point and the root cause because we're too afraid to upset and to cause someone to, you know, react accordingly.
And so that again, is the goal is like don't attack the individual, call out the behavior, and then use that behavior to then understand the incentives and why they're performing in the way that they are.
Because once we understand that, then we have a hope at flipping it and turning it around and doing something different as a result of it.
[00:06:26] Stacey Richter: Also, some of these stakeholders. They are huge, huge organizations like, you know, you can't say this hospital did this and, and think that some kind of democratic vote was taken, and all the doctors and nurses are yeah, actually on board with that, right? Like that is so often, I'm gonna say 99.9% of the time really not the case.
And often it's quite surprising to some who work at some part of the organization to see what somebody else is doing. So there's also just even being aware of what is going on. This is news that many have found they can use. And if somebody is coming here for some pretty, so I won't use the word blunt straight.
I'm not sure what the right word is, but that's what we do around here is just no judgment flat out just that this is what's going on.
Conclusion and Call to Action
[00:07:13] Stacey Richter: Hey, thanks for listening to this bonus clip. Now do go back and listen to the other show that was released at this same time, episode 483. You will find it in the feed released on this same day, part one.
[00:07:26] Tom Nash: Hi, this is Tom Nash, editor and producer of the RHV Podcast. You've probably heard me say this podcast is sponsored by Aventria Health Group. And that's true, but there's more to the story.
Aventria is our day job, and the people that make this show happen are Aventria employees generously donating their time and talent on top of everything else they do to get each episode out the door.
So yes, Aventria underwrites the production, but in many ways, Relentless Health runs like an unofficial non-profit, a very, very non-profit. Aside from the occasional and deeply appreciated episode sponsor and our wonderful listeners who donate to the Tip Jar, this show is scrappy and self-funded.
If you wanna keep this podcast independent and laser focused on educating, informing, and driving real change in our healthcare system, we invite you to become a monthly sustaining member of Relentless Health Value.
We have a few of you who have already taken it upon themselves to do this already, and we are deeply grateful. Maybe in the future we will be able to cook up some perks. Could be mugs, zoom meetups, and other ways to connect with like-minded listeners who care about the same things you do. So if you find value in what we do each week, head over to relentlesshealthvalue.com/donate and donate to the tip jar.
Maybe become a sustaining member. Or if you or your organization wants to sponsor an episode or two, we'd love to chat. Thank you so much for listening and being a part of the movement.