Matt Harrington 0:00

Hello, everyone. My name is Matt Harrington with the A Train of Thought Podcast. Today's guest is Roger Jansen, PhD CEO and Board of Exponential Health, a licensed clinician and healthcare executive with deep experience in the strategy, innovation, behavioral health, and organizational growth. He's also founded two technology startups and previously served as chief strategy officer and CHRO for one of the nation's largest health systems. Roger, thank you so much for being here.

Roger Jansen 0:28

I'm glad you do it. Thanks for having me, Matt.

Matt Harrington 0:29

So I'd love to kind of hop right into the background. I'm curious what pulled you from clinical psychology into healthcare leadership and eventually entrepreneurship.

Roger Jansen 0:39

Wow, that could take the whole podcast to answer that one. So when I began, I was really focused on MD PhD programs, kind of what could I do? And do I want to be a clinician? Do I want to be a researcher? Ended up by actually wanted to be a researcher and really enjoyed asking questions and setting up and doing design and analyses to figure out, you know, how to use this question. While doing that, I had to do clinical work. And so it was a requirement to see patients. And um, I really got pulled into the neuroside, much more of the traditional clinical side. And I began to ask questions like, why do we do these things? And some humans behave this way and some humans behave that way, and nature versus nurture, and where does the brain play a role? So I got very interested in kind of neurotransmitters and neuroanatomy and how those different functions drive behavior. And I ended up leaving the clinical side altogether for two big reasons. One, it was, and I give a lot of our clinicians incredible credit. It's very taxing, it's very difficult work. You become very engaged with it at a level that until you do it, you may not appreciate. And two, uh, on the research side, I found myself sitting in a hospital writing a grant one night, looking outside in the cold winter about five o'clock in the afternoon, saying, I don't think I can continue to write grants for a living either. And so came from a family-owned business and was always kind of in great games with the business side. But it was really at a departmental meeting where I was figuring out how broken the U.S. healthcare system is, and that we're really set up to build CPT codes versus take care of people the right way. And when you're really treating people based upon what insurance dictates versus what you know what's right for the patient, it's frustrating. And I was not the right person to continue to work in that type of system. So I said if we can't change the system from a clinical side, can I get involved in the leadership aspects of healthcare and begin to make a difference? And that's really what moved me out of the clinical slash research side into the administrative leadership side.

Matt Harrington 2:38

It's interesting when you step into leadership roles from clinical side or from clinical and research side. Do you think that changed the way you lead today? And have you met other operators who you wish had more clinical and research experience?

Roger Jansen 2:53

Yes and no. I think it certainly gives you perspective and how you look at the problems in front of you. And, you know, every department, whether that's a neurology or it's uh oncology or cardiology or nephrology or whatever department is, that's the most important thing to them at that point in time. And what you begin to quickly realize is that every issue is relevant and every issue is important to somebody, and it's the most important thing to someone. What I think you begin to appreciate is that the system itself is not designed to answer those problems. The system is designed for complexity and for accumulation of revenue, not necessarily best treatment of patient. And I think we lose sight of that in this country. It reminds me a little bit of what somebody said. My mom used to be the president of our school board when I was growing up, and boy, you hear a lot then. And one of the things I remember a patient or a patient, a member of the community saying is, we love our teacher, but we hate our school. And I was like, wow, it's really interesting. And it's kind of like I love my doc, but I hate the healthcare system. And the system really is not set up for patients. And it's not easy to navigate. You can't understand it. Employers can't figure it out. We put employers in the industry of being healthcare experts when they're making widgets or designing websites, and now they suddenly have to also be healthcare experts. It just doesn't make any sense. So I guess my empathy for both sides is increased, but I can't say that one side has it figured out and the other one doesn't. I think we all have to come together to solve this problem.

Matt Harrington 4:22

Aaron Powell What factors do you think led to the system looking the way it does? You know, especially from the business perspective, talking about billing CPD codes, maximizing revenue. What led to that?

Roger Jansen 4:35

I mean, there's a lot of history on it. Um, if you go back to the 1980s, some of these changes started taking place with Centers for Medicaid and Medicare Services. We started seeing more uh derivatives of different insurance products and types that can be put into the market. And we began to allow doctors not to be able to own and operate hospitals, but we allowed others to own and operate hospitals, people who don't actually understand how to actually deliver care. And I think we've missed some of the foundations as we've gone along. I've told people time and again, healthcare is simple. We have intentionally made it complex. Why do we need a PBM involved in figuring out what drugs should cost? Why no other industry does that? You don't go to Best Buy in Dallas and pay a different price for your computer than you do for a computer in Grand Rapids, Michigan. It's the same price. Um yet I won't get the same price with a youth care facility. And we do that because of facility codes and DRG codes and CPT codes, and we do that because we have complexity that we don't understand cost accounting in healthcare. So I think what's made it more complex, uh, and I want to be careful how I say this, is we've designed it to be corporate medicine, and we're treating healthcare system executives like they're Fortune 500 CEOs, when they should be treated very similarly, I think, to the respectful positions of superintendents in the community or a government official, um, a mayor of a community. But to be treated and paid like Fortune 500 CEOs when they don't do anything to actually grow revenue, people are as long as your community and population is growing, you're going to get more sick people, more babies, and more injured people. You have to do absolutely nothing to require more health care. And then in the state of Michigan, for example, there's something called a certificate of need. Those CONs, essentially, what they do is they drive competition outside of the market. So if you want to open an imaging center, for example, you have to get state approval to do that versus allowing those with the best outcomes and the best prices to win, which is exactly what you find in any other industry. So you actually take consumerism and the formations, the foundational principles of capitalism, completely out of healthcare. And to me, that's where I think we've gotten off track and we've rewarded these groups like they're doing something magical when many of them aren't even around. They're on outside communities and on national committees and international committees. They're not even taking care of multiple communities that they live in.

Matt Harrington 6:59

So then how does the alternative method of exponential health come into the equation? Because especially talking about complexity, your website's very straightforward with the type of care you offer.

Roger Jansen 7:10

Yeah. So what we did is we looked at what do most people need working ages 18 to 65. And we went and we looked at a bunch of historical data from the last 10 years. And it came down to, and I'm not going to get them in the exact order, but it came down to about seven professions. Primary care accounts for most office visits. But here's the problem with primary care in the United States. Each doc has a panel of 2,500 to 3,500 patients. You cannot take care of people with 2,500 and 3,500 patients. And as a result of that, primary care, instead of becoming a treatment or preventative solution, has become a triage solution where we have to move it on to the specialist or the image or to take off the skin tag or remove the mole or do the joint injection. Instead of doing that, the office. And so we don't even focus on prevention. The second set is mental health. We have a huge mental health crisis in the country. Yet we prescribe more SSRIs, SNNIs, and NDRIs and others, any other in organized, I said competitive organizational entity like Italy, Spain, France, so on and so forth do. Yet we have the worst mental health outcomes. Then you get into optometry, you get into gynecology, urology, musculoskeletal orthopedics. And what we said is let's bring all those in-house and let's treat most of what people need, but let's do it to it at a contract-based price that doesn't require people to guess what they're going to get charged somewhere down the low down the line. So we have become a direct contracting to employers and to self-paying individuals. One price, that's it. Never build again. No surprise billing. You know what you're paying up front. And it's at about 125% of Medicare rates. And so if you can't afford quote unquote the treatment, we're about 125% of Medicare versus traditional insurance is somewhere between 270 and 320% of Medicare rates.

Matt Harrington 8:53

So how does that let people shift the focus from triaging to prevention with their own healthcare?

Roger Jansen 8:59

Because our physicians only see 600, 300 to 600 patients apiece. And so their panel sizes are much less. So they're, you know, their visits are 45 to 60 minutes each time. So you're not only, you know, saying somebody, but we also kind of say we're like the wealth planners for your health. So we're the health planners. And what we mean by that is when you sit down with somebody in your 40s, their question if they're a good wealth management planner is what do you want to be doing in your 60s and your 70s? We do the exact same thing with someone's health. You're in your 30s, what do you want your 50s and 60s to look like? You're in your 50s, how do you want to be behaving in your 70s and 80s? Because you can't take action in your 70s and 80s. You need to take actions in your 50s or 60s. And so we're really doing that advanced management and wellness and health actual treatment. And I make a distinction. We are a healthcare company, whereas hospitals are medical companies. There's a very big difference between being a health company and being a medical company. We're focused on health and wellness. And if we need to treat you medically, we're licensed and capable of doing that. But our real goal is to keep you healthy and well for as long as possible. And let's remember what year we're in. We're in the year 2026. 2026. Many are practicing medicine and CPT codes from the 1980s because that's what they get reimbursed to do. It does not mean they're getting treated with the best outcomes or the latest and greatest ability that we have right now to take care of them. And that's that's an indictment on the U.S. healthcare system.

Matt Harrington 10:23

Do you see general healthcare shifting closer to your model over time, or at least a model closer to preventative medicine?

Roger Jansen 10:32

I think it comes down to what is going to happen from who pays. Right. And so if you look at who is the payer, the reality is right now, people don't appreciate that employers before the employee deduction are paying about $2,700 a month per employee for health insurance for a family of four. That's $30,000 a year that you're not seeing in your quote unquote take-home pay. I think what you're going to see employers do is move to defined contribution versus defined benefit. And so they're going to give you, make it up, $2,000 a month, and you go out and figure out what your own health care looks like. I'm going to get out of the healthcare business. Once you see that, I think you'll see a movement towards people making more disciplined and informed decisions about how and when they receive their health care and how they stay healthy and well before they get ill and injured in advance. So I think it's going to take a shift before we see that happening. I don't think it's going to happen organically, unless I think it already would have. Now the good news is, it's good news and bad news, is I think healthcare has become so unaffordable that there's more people being proactive. I think healthcare has become so unaffordable. Employers are starting to say, okay, you want me to go to your galas and spend money and give you dollars and donate time when you're putting up billions of dollars in infrastructure annually, but you're not lowering our healthcare costs, improving our access or improving our outcomes, we're done. So I think you're going to see a reaction from the business community because I think we've hit that breaking point where enough is enough. And organizations like ours are starting to thrive because we're actually doing something about that gap. And we're actually treating them based upon a budget and treating them based upon desired outcomes and making sure we don't have to treat, we can prevent before they ever have to spend those high dollars.

Matt Harrington 12:16

Can you talk about the it's interesting? We were talking about the financials. Can you talk about maybe the convenience aspect of the different types of medicine as well? Because as a busy dad of three with, you know, a bunch of activities at night, it a lot of times it comes down to effort. How easily can I get to the dentist?

Roger Jansen 12:33

Yeah. So, you know, all of our people that are members of our company or patients, if you will, of our company, we guarantee same day or next day access, right? And why do we do that? Because I'm sick today. You know, we have in and when we can't take care of them personally, we've created our own network of about 51 independent physicians' groups. And this is everything from imaging in labs to surgery, um, to neurology to you know, neurosurgery even. And the reason we do that is so we can help them get access to those services sooner than later. I had a patient I was working with who we suspected multiple sclerosis. We had to get some imaging done and some other testing done. They had called to go through a traditional health system in our community, and this is not an exaggeration. It was a 148-day wait before they could get in. Okay. We got them in literally the next day and had results in the evening, 12 hours post their their imaging. That's a big deal. And so I think the convenience factor, healthcare isn't just about when it's good for the system. Healthcare should be about when it is needed by the patient. And that's really what we're trying to get back to.

Matt Harrington 13:45

Shifting a little bit into the business side of the equation, uh it's a pretty competitive space, healthcare, behavioral health, the whole gambit. What is working right now in terms of getting new clients, getting new docs, you know, building the business in that way?

Roger Jansen 14:01

Our business has grown about 5x in the last 16 months. So we're growing at a very, very rapid rate. Our biggest issue right now is recruiting. It's it's hard to get people on and get the right people on. Um, I think the way that we're growing is twofold. And I don't mean this to sound silly, but we don't have to be that great. And maybe we're not. And maybe we have a long way to go. But I know we're better than the options that are currently being utilized. And so, you know, our food may not be the best restaurant in the state, but it's better than the one that are currently in town. And people are like, I think I'm gonna go there instead. So we have a long way to go. And so I think we're the best organization we can be. And, you know, I don't think you're ever done with that journey, so we'll probably never attain it. Um, so I think that's one thing. And the second thing is I think healthcare brokers are tired of presenting two solutions. In our state, it tends to be the Blue Cross Blue Shield solution and party health. And they're looking for other solutions that employers are saying enough of the 10, 11, 12, 15% increases annually. Can you bring me something different that's gonna actually keep my people healthy and well and improve the health outcomes and lower my total cost of care? And that exp and that's exponential health.

Matt Harrington 15:08

Very interesting. So you said recruitment was one of the barriers. Is that because you have trouble getting docs to this new style of care, or is it even getting in front of them to begin with?

Roger Jansen 15:19

No, it's because healthcare systems have put non-competes in place. And so we have a laundry list of doctors who want to join us, but they're all in non-competes, and so our ability to actually get them and the pace at which we can get them is impeded by that legality, of which let's remind ourselves. Let's remind ourselves, lawyers are the only group that do not allow themselves to have non-competes, but they write them for everyone else. So the legal profession is also complicit and implicitly, you know, causing the problems in healthcare as well.

Matt Harrington 15:49

I did not know about that, about uh the legal stuff.

Roger Jansen 15:52

That's the entire system is set up for lawyers to bill more, right? I mean, that's what they enjoy, that's what they do. And unfortunately, the United States, I believe, accounts for 94% of all lawsuits globally. Yet only 6% are filed outside of that. Because there's no standard for filing a lawsuit in the United States. Anyone can sue anyone over anything and say anything they want. And so we we really, really have to get back to uh some sanity here. But all the lawyers are the ones who run for public office and they all protect their profession. So it's an inside job.

Matt Harrington 16:22

Giving taking a couple of steps back into when you were in the in the midst of scaling, maybe early on in the process in the swamp of it. What's uh what's a piece of advice you would give a healthcare operator who is feeling overwhelmed but trying to scale?

Roger Jansen 16:37

I wish somebody would told me this at the time, but it's it's gonna sound really silly, but it's okay to not know what you're doing all the time. And and what I mean by that is listen to the patients. You don't have to have all the answers. Seek advice from others to give you those answers and what they're looking for. And we've been really good. Actually, we just had a patient meeting today and we asked the patients what do they want? You know, why do we have to consistently come up with the answers? Like, let's ask the patients what they're looking for and let's really spend time building what they want. And so we're co creating a vision versus taking our vision and forcing it down people's throats. We're building it with our patients.

Matt Harrington 17:17

I love it. I think it's a great place to end it. Thank you so much, Roger.

Roger Jansen 17:21

Yeah, glad to be here. Thank you.