Inside the Impact Board: Esther Dyson and Roger Jansen on Why We Need to Reimagine Healthcare
Health systems aren't designed to keep us healthy, say Esther Dyson and Roger Jansen. They discuss how to change the model, empower communities, and bring humanity back into healthcare.
We flipped the script and asked two esteemed members of our Health Moonshot Impact Board to interview one another. Esther Dyson, legendary investor and founder of Wellville, sat down with Roger Jansen, PhD, Chief Innovation Officer at MSU Health Care, to chat about the future of health and why building community is so essential to long-term thriving.
Effectively Under-Insured
Esther Dyson: Roger, tell me what you're up to right now.
Roger Jansen, PhD: Well, Esther, the things that I'm focused on right now are shifting a little bit. One of the things that we’ve been made aware of at Michigan State University is the extreme pain our employer partners are finding with healthcare costs right now. What we've done is we've actually formed a group of employer companies around the state to come talk to us about what we can do to not just improve clinical outcomes but cost as well. If people can't afford to use the healthcare it's almost as if you don't have any healthcare whatsoever. Many people may not know, but this is the first year in US history that people with health insurance carry the most medical debt versus those who are uninsured. We've hit a milestone here where people have insurance but they're effectively under-insured. So we’re looking at how do we change the business model for delivering healthcare. Ultimately, that's what we need to do.
Esther Dyson: Part of what's going on also is we keep talking about health literacy. “These people need to do the right thing and they need to follow our directions.” But the reality, I think, is that healthcare systems and the clinicians need life literacy. To understand the reality of people's lives. You're not competing one drug versus another. It’s one drug versus making a car payment or it’s between taking the kids to school and getting to the doctor. Probably the biggest thing AI can do is understand long-term impacts, understand the counterfactuals. Investing this $50 million right now in reducing obesity or in maternal health, probably most importantly, has impacts 20 years on. And that's been shown. So one part of me says, well people just aren't paying attention to the data, but as AI becomes more prevalent, more believable, and you can apply it locally, this notion that you can actually see the impact early of the money you're spending, rather than waiting 20 years for the outcomes. But someone has to pay for that. It should be the government and they're unwilling to pay for anything more than two or three years out.
Health Maintenance
Roger Jansen: Yeah, and top of that, our entire business model in healthcare is based upon illness and injury. It’s not based on keeping people healthy and well. You have a real conundrum. I challenged our group and said who do we call if you wanna stay healthy? Nobody knows. There's nobody to call. So we have it backwards. I think in this country where we're spending dollars. We're spending $4.6 trillion in healthcare. We're not spending anything that I can tangibly figure out on health improvement and wellness.
Esther Dyson: Health maintenance! Exactly. Do you know the website RealAge? Charlie Silver sold his company to Harrison then ShareCare. Do you know who he sold his previous company to? Jiffy Lube.
Roger Jansen: Are you kidding me?
Esther Dyson: Yes. Maintenance. He got it. He said why are we maintaining our cars and totally forgetting our bodies?
Helping Communities
Roger Jansen: You've been working in this space for a long time with Wellville. What are some of the lessons you take away that you think you can apply at scale to these problems?
Esther Dyson: That's what we are hoping to do. I'm going to write a book called “Don't Rent Your Community's Health From an Absentee Landlord.” But the trick is it's not a nice white lady coming in and telling people what to do. And it's not even teaching people to fish. It's helping the community to build its own sustainable fishing schools. People get addicted to drugs and to short-term relief, whether it’s “I’m going to go buy that skirt because it gives me more pleasure than that stupid medication.” Community organizations get addicted to short-term grants because they have to stay alive and they have people to pay.
So not only do they become short-term oriented, they start competing with other community organizations instead of working together. And then at the other end, VCs and private equities get addicted not to sustainable businesses but to exits. So we're very focused on helping them build their own community fabric versus fancy structures, whether they're big philanthropies or not.
The good parts spread. So do the bad parts. Try to find the ones that are successful because they will help the other ones.
Roger Jansen: So you're really talking about putting an infrastructure in place, the old ‘teach somebody to fish versus give them a fish.’
Esther Dyson: Not exactly. We ask questions and help them discover their own answers. It's like with your kid, don't bribe them to do their homework. Help them discover the beauty of math. Show them how to use math to do baseball scores. When I was six I started counting my chicken pox.
Roger Jansen: I have a feeling you were doing quantum physics at six.
Health Outcomes, Not Just Cost
Esther Dyson: So at MSU, what are you doing to move this ball forward?
Roger Jansen: We’re working with CEOs and corporations around the state. What's interesting about this is that it’s actually the business people, not the healthcare folks, who have spurred us to action. One of our not-to-be-named CEOs said, “you know I employ a company of 700 people and I'm writing the second-largest check every year to healthcare, yet I have no input on where its costs are, no feedback on its quality, no better experience, no improved access, and no improved long-term outcomes. What am I getting for this 24% increase this year?” That’s a very, very small example, but I think what we're dealing with is that this is happening everywhere in the United States.
No incumbents are taking on the challenge of lowering cost. What we continue to see is more consolidation, less competition in the market, less adoption of innovation. As soon as we do that, they wanna be paid like capitalist companies, yet without playing by capitalistic rules. You can't have it both ways. I think that's ultimately hurting the greatest foundation in many ways our country has, which is our employer. We can't keep putting the bill on their backs.
Esther Dyson: Well the good news is they’re starting to ask, ‘what am I getting for this?’ And the outcome, it's not just healthcare costs, it's healthy employees. I want my people engaged, I want them productive. Tell the guys at MSU to do a study of mental health support. And the population they need to study is not the people directly being supported, but the people that report to those people. Bad bosses are what drive people away. Good bosses are what make people healthy. It's like train-the-trainers.
Roger Jansen: We need to look at ourselves as an employer, too, and not just as a provider. I think that's part of where we sometimes forget. We have 20,000 people to take care of that we employ and – I think with their dependents – like 77,000 people that we ultimately take care of in our own company. If we don't take a look at the mental health of our own people, we're probably not able to do this well for others.
Esther Dyson: I would imagine so. And you’ll be more effective at everything else you do.
Permission to Imagine What It Could Be
Roger Jansen: So let me ask you about Wellville. You have this idea and you’ve launched so many incredible programs, including one in our backyard in Michigan. What were some key takeaways you learned from these programs?
Esther Dyson: Wellville is not a launcher. One thing that I wanted people to do was get flu vaccinations. This was before Covid. There was no local take-up. People were busy. The things that started working were things like the YMCA Diabetes Prevention Program. Which is a really interesting story. Trinity, formerly Mercy Health, got a CDC grant for diabetes prevention in I think it was six of their regions. In Muskegon they decided to give it to the YMCA, rather than do it with expensive doctors and clinicians. They wanted the YMCA to do it because they’re actually reaching the community. So the first thing that happened, I was talking to one of the people at the YMCA and we were talking about how to get referrals from Mercy. Even though Mercy had given them the program, they weren't giving them the patients, and I said what you really need is an API to work in your HR. And the person said: “Where would we hire one?” So I explained what an API was, but the reality is I was mistaken. Yes they needed the software to work and to make everything smoother, but what they really needed was an amazing personal interlocutor between the two systems. They hired somebody from Mercy and then suddenly she knew who to talk to at Mercy. She went and talked to the doctors and said send us your pre-diabetes patients, we’ll take care of them. Suddenly it started working. When Covid happened, they went online and now they're offering diabetes prevention through something like 16 YMCAs around Michigan.
At one point I asked, “what would you do if you had more money?” They said, well, we'd hire two more counselors. The town had 180,000 people. I said, “what would you do if you had ENOUGH money?” Suddenly that's when things came into focus. Again, we were just catalysts, asking those kinds of questions that make people feel their own possibility rather than, ‘I got an assignment from somebody to do this.’
Roger Jansen: You're giving people permission to imagine what it could be versus accepting their current limitations.
Esther Dyson: Yes and you want people to realize they don't have to ask for permission. Wellville has no power to give them permission because we have no contracts with them in either direction. Possibility is an action or a decision. Physical health begins with mental health. You need all these things – good food, good environment, so forth – but you also need a feeling of purpose, a feeling of connection to people, and some sense that if you do stuff it will have an impact.
The Paradox of Technology
Roger Jansen: There’s almost a paradox that I think is happening, too. There was a psychoanalyst back in the 30s and 40s who wrote about the paradox of choice and then the paradox of technology. I remember the whole idea that the more advanced that we become technologically, the less human we’ll become. Therefore we’re going to get away from what is really natural for us to do, whether that's movement, socialization, coming together to worship or whatever it may be. It seems like we're kind of there. I’m curious, how do you think we can bring a sense of humanity back into such a technologically-driven environment?
Esther Dyson: Well first of all I agree. I believe it could be impossible to make things better and I have decided to take hold of the tiny possibility that I can help change that along with hundreds and, ultimately, millions of people. But if you sit and do nothing, certainly it's not gonna get better, right? If you try and do something, you'll be part of that possible change. Doing this podcast as part of saying, “Hey folks, give it a whirl.” Don't just sit there. Find people and help them empower themselves.
Be a Part of the Change
Roger Jansen: I think a lot of people don't take action because they think they don't know enough. Or they're not the right title or in the right position. To me this is just about being human again and reconnecting with things that we're supposed to do. You know I'm trained as a psychologist and I sit back and say the biggest determinant we've ever known if somebody gets better psychologically is social support. It’s not medication. It's not anything else. It’s ‘do you feel like you have people who will help you?’
Esther Dyson: This reminds me of the movie ‘Her.’ The guy falls in love with an AI called Samantha and then he discovers that she's got 1500 other lovers. And it's not that she doesn't spend enough time with him. It's fundamentally a time-scale difference. But what he wants is her attention. He wants her to need him, and she doesn’t. Mattering to somebody is different. An audience sits there. If you’re a member of an audience and you leave, nobody notices. In a community, if you’re not there, people notice. And if they don’t it’s not a real community.
Roger Jansen: That’s a great point. Anyone who is listening to this (or reading it), Esther and I are encouraging you to be a part of the change and take action. Because we need it.
Esther Dyson: And recognize the other people around you.
Listen to the full interview on the StartUp Health NOW podcast:
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