About Jan Berger, MD, MJ
Jan is a tri-sector healthcare executive that has proven results as a senior executive in the three sectors of private, public and government services over the last 30 years. In 2009 Jan founded Health Intelligence Partners as a health care consultancy. Health Intelligence Partners has a global focus (engagements in 14 countries with both Health Organizations and National Ministries of Health), working with clients on areas of growth including short-term and long-term business strategies and solutions. Health Intelligence Partners helps clients to navigate intersection of strategy and operations within both the healthcare and consumer goods and services environment in order to identify and articulate value opportunities.
Prior to founding Health Intelligence Partners, Jan served as Senior Vice President, Chief Clinical Officer and Innovation Officer for CVS Health/Caremark. During that time, she was a corporate officer and on the executive team with P & L (500 million-dollar business unit), operations and strategic experience. Jan also lead Caremark’s Medicare Part D development and was the clinical lead for CVS Caremark’s M & A activity. During this time, Jan developed an expertise in both healthcare and retail consumer behavior. Before going to CVS Caremark, Jan had 15 years’ experience in healthcare administration within the health plan and academic arenas and lead operations for two population health companies.
As a veteran healthcare executive, Jan’s leadership has delivered results in a variety of settings. Jan offers her experiences and insights through her consulting agency as well as through her participation on healthcare and consumer product boards. She also sits on numerous business and healthcare advisory boards.
Jan has recently released, Re-Engaging in Trust: The Missing Ingredient in Fixing Healthcare. As the author of four other books and editorial board activity on several healthcare journals., Jan is considered a national health care thought leader.
About Health Intelligence Partners
Health Intelligence Partners was founded in 2008 as a global health care consultancy. The organization brings a unique blend of health and consumer behavior expertise to help solve the unique challenges that their clients face. Health Intelligence Partners supports its clients with operational and business strategies in order to improve effectiveness and efficiency of actions with the goal of maximizing corporate value.
Medical Travel & Digital Health News (MTDHN): Tell me about your background and your recently released book about issues impacting levels of trust in the U.S. healthcare system.
Jan Berger (JB): In 2016, I was leading a healthcare consulting company, and we were seeing some changes societally and within healthcare around how people interacted with each other. We conducted quantitative interviews to see if we could call what some of the differences were. The initial research that we did led to qualitative interviews that further defined the issues. The journey then led to us writing the book.
The book, which I authored with Julie Slezak, “Re-Engaging in Trust: The Missing Ingredient to Fixing Healthcare.” The premise of the book is that we have an unsustainable health care system in the Unites States. If we want to create a system that addresses quality, access and cost we have to make changes.
Unfortunately, no one has talked about the need to address the lack of trust that exists in our healthcare system today. The book addresses the issue that although healthcare is the most personal of interactions, the U.S. healthcare system is grounded in a business model based on a win-lose paradigm. Unfortunately, recent events both in society at large and within the healthcare industry have created negative trust resets that have only magnified the problem.
Healthcare is unique in that it personally impacts every individual in the United States. If we are to address the challenges within healthcare, we have to do more than alter payment and organizational models.
We have to address trust. This will require a conscious behavior change by each stakeholder to improve trust across the system.
MTDHN: Who is your audience?
JB: It’s for all stakeholders, those people who can impact or are impacted by trust in healthcare, which is everybody. Right now, I’m doing webinars and podcasts across the healthcare industry. We all have to buy in for there to be real change.
We focus a great deal of attention on the COVID-19 pandemic as a trust reset event. Everybody who I’ve taught has focused in different areas, whether it’s what their role is, what their events are, what their personal experiences have been and so forth. It has touched people.
MTDHN: What are some of the most egregious examples of trust erosion?
JB: Trust is really tied to vulnerability. Whether it’s a parent or a healthcare provider or a mentor, we believe these individuals have our backs, that puts us in a vulnerable position. When they don’t have our backs, it reduces our innate desire for trust.
For example, in 1973 the HMO Act did some wonderful things, but it also eroded the relationship between stakeholders in healthcare. It was the first time that insurance became for-profit and publicly traded. This threw incentives out of alignment for all of the parties. Providers felt stymied about what they could do for their patients because of this third-party involvement due to focus on utilization management and gag clauses. This created a huge negative trust reset between insurance companies, providers and their patients.
Regardless of the changes in health insurance such as HMO and other health insurance models, healthcare providers, as a whole, are trusted by their patients. The corporatization of healthcare has created a situation like the early HMO world in which they are increasing a negative impact on trust. Patients begin to wonder: “is this medication right for me or is my physician being incentivized to prescribe it?”
The residence of trust between physicians and their patients does seem to stand the test of time. This trusting relationship is most strong when physicians use “social cement” to build the relationship. This trusting relationship allows the patient to be vulnerable and still trust that the physician “has their back” and will act in their best interest.
Along with the increasing corporate nature of healthcare, the pandemic has also had a negative impact on the trust that people had conferred on physicians prior to the pandemic. Many physicians were furloughed or their offices shut down and this left people feeling abandoned by those that they trusted.
MTDHN: How has the pandemic impacted public trust in our healthcare system overall, and can it be restored?
JB: We just spoke about how that pandemic impacted trust in healthcare providers. Another healthcare stakeholder where the pandemic impacted trust was the pharmaceutical industry.
This is a group where there has been very low trust levels since the early 1990s. This is due to the hyper focus on drug costs over the clinical impact of medications. Over 50% of individuals in the US are on chronic medications and feel the impact of the high costs of medications. The out-of-pocket costs really impact individuals and families and has created frustration and reduced levels of trust in the industry.
The pandemic has created an opportunity for the pharmaceutical manufacturers to regain trust through their use of science and development of vaccines in record time. For those who understand how amazing these breakthroughs are, trust in drug companies has gone up.
MTDHN: So why doesn’t everyone trust vaccines?
JB: There are several reasons for distrust of the Covid vaccines. One negative trust reset is due to how the information regarding the Covid vaccines has been communicated. There’s been conflicting messages about the vaccines, to a large degree because we were learning while living through it and we are always learning new information.
Another contributor is something called historical reasoning. We have a number of cultures that feel like they have been left out historically and during the pandemic on the testing of safety and effectiveness of the vaccines. This has created cultural distrust among Blacks, for example, especially in light of the “Tuskegee Study of Untreated Syphilis in the Negro Male” and other incidents that historically can’t be erased and have to be acknowledged.
A third reason is how other countries have addressed vaccination and masking. We are the only country that makes healthcare a political conversation. I was in Belgium a month ago and masking is mandated. Vaccines are required in order to go into restaurants and gyms and so forth.
If they choose to be unvaccinated, they accept that they can’t go to these places. It’s not a political wrestling match. So, a great deal of distrust of the vaccine in America has nothing to do with the vaccine.
MTDHN: Does lack of trust impede better outcomes for underserved and ethnic populations?
JB: Yes, it does. People tend to trust people who look, sound and think like them. One of the differences we found between our first and second quantitative study for the book was a 24% decrease in trust of neighbors, friends and family members.
If we want to change the trust dynamic, we first have to acknowledge this trust gap. Second, we have to decide that we have a responsibility to overcome it. That’s why each of the 15 trust resets have both individual and corporate actions that need to be taken. I would argue that until we directly address them, the financial and functional challenges we have in healthcare will not give us the positive outcomes we are hoping for.
MTDHN: What do you foresee with Medicare?
JB: As far back as the 1960’s Medicare quickly became a highly trusted governmental program supporting seniors. This trust model for seniors has continued up to today. I do not see that changing significantly. Dental and vision are as vital as a mammogram or cardiologist in terms of the impact on health. So, adding them to Medicare is a positive, supportive trust action that will continue to strengthen the trust of an already trusted program.
Interestingly, over 50% of the country is covered by governmental healthcare including Medicare, Medicaid, VA and Department of Defense. These programs all have been found to be highly trusted by those covered under the programs. Interestingly, a large portion of those not covered by these programs lack trust in the government as a healthcare payer. This has created the gap in trust when talking about single payer systems.