Jason Dana Costa 0:00

Hi, everybody, and welcome to Worth the Work with Jason Data Costa. Today's guest is Dr. Roger Jansen, a psychologist, healthcare executive, and CEO of Exponential Health. He has spent his career leading large-scale transformation and challenging traditional models to create better outcomes for organizations and communities we serve. Roger, welcome to the show.

Roger Jansen 0:22

Yeah, thanks so much for having me. I appreciate it.

Jason Dana Costa 0:24

Oh, we appreciate it too. I hope it's wonderful out there in Michigan right now. It's been a great place to visit in the past, particularly in the late summer.

Roger Jansen 0:33

So we complain about the cold, but now we're complaining about the heat. So hopefully we'll get that sweet spot here.

Jason Dana Costa 0:39

Understood. So here at Worth the Work, I tried it really hard to connect the experiences everybody had growing up to what matters now in their work as professionals. So the first question I wanted to start off with was before your healthcare and leadership sort of entered the picture for you professionally, what in your upbringing helped teach you how to about people or responsibility and knowing what work matters?

Roger Jansen 1:01

Yeah, probably like most people, your parents are a huge influence. I think my mom in particular, my mom was an educator. She's a biology and anatomy teacher, so I was always around and gravitated towards the sciences and the biological sciences pretty hard. But she was also a really big leader in our community. So she was always involved in things like president of the school board, the PTAs, the not-for-profit fundraisers, all those types of things. And showed me the importance of making sure that you give back to your community and understand how you can help people be successful. And for us, it was always about what we can do to help other people versus kind of how you help yourself, which in some ways in corporate America is sometimes a big clash. So especially in healthcare where we have a lot of not-for-profit quote unquote health systems who would pay their executives like Fortune 500 companies and protect their positions, and yet they're hurting the community by their rising cost and by making healthcare, which should really be a right for people to be something they can't even afford to engage.

Jason Dana Costa 2:03

Wow. Is that what inspired you to become a psychologist?

Roger Jansen 2:08

So, my area, I actually was in an MD PhD program and really gravitated towards the research side and really want to take a look at how the brain operates and how can the question that really got me was how can people put people into burning ovens and kill them? And how can somebody run into a burning building and save someone? And our species is really unique in that we do both. And it always came back to me that has to be somewhere in the brain. And so really focusing on how the brain operates, processes information, functions from a neurochemical, anatomical perspective. And I would say that every time we learn something, we learn a little of something that's going to be a long journey. So it's fun to be involved in the research side of it. So I think that's why I kind of gravitated in that direction.

Jason Dana Costa 2:55

And is that what Exponential Health does? Are they like a contract research organization? Are you looking for molecules?

Roger Jansen 3:02

No, we're a medical clinic, so we see patients. We really serve as an alternative health system for employers. So we do a lot of direct contracting with employers so they don't have to go through the existing insurance system or the existing rates with other health systems. So we contract at about 125% of Medicare rates. And so we provide, let's say, I'm making this up, a knee surgery would cost you $50,000 based upon your traditional employer-sponsored insurance. And because they're charging anywhere from 260 to 340% of Medicare, we charge about 125%. So you're probably going to save 60% on that surgery.

Jason Dana Costa 3:39

Interesting. So uh essentially you're working with self-insurance programs?

Roger Jansen 3:44

Working with a lot of self-insured employers, correctly. Yeah. No kidding. So captives. Yes, that would be one. I mean, it depends on what way you're using that term. Insurance captives a little bit different, but in some ways, we provide the insurance the back end of the health care from the TPA to the network, but we don't actually have a wrap. We have wraps for things that you might need that we don't have, like emergency rooms and those things.

Jason Dana Costa 4:10

No kidding. Wow, that's an interesting model. Candidly, I'd never heard of it. That's kind of great. I've I am very familiar with sort of the captive and self-insurance model that's worked before. Built that up in one of my previous organizations, as well as part of one of the organizations I work with today, Horizon Pharmacy, who works to provide pharmacy services cheaper to captives here in Rhode Island, which is where I'm located.

Roger Jansen 4:33

Yeah, we have our own pharmacy as well. And we have contracts with 51 independent groups from imaging to surgery to everything, all to try to actually do something crazy, which is actually take the insanity out of healthcare. And it could be done, but too many people are making too much money off of it and it's harming too many folks. So it's a mission for us. We we just don't think it's right that people have to cut pills or not get procedures done in the quote unquote wealthiest world or country in the world, and yet we can't take care of people with basic problems. So we're trying to change that and we're making progress.

Jason Dana Costa 5:10

Wow, that's great. And are you just in Michigan or is it uh exponential out?

Roger Jansen 5:14

We have offices in Michigan. We'll probably begin to expand throughout the Midwest soon, but we're a unique model, and a lot of HR folks just like to hit the easy button and go with the traditional insurance companies. So getting them to understand how our model works takes a little bit of time and takes leadership from an organization that wants to make change. A lot of family-owned businesses love to engage with us because every dollar they spend on healthcare unnecessarily is a dollar not going back to their family. So we we're very cognizant of costs are out of control. You've got health systems putting up $1.7 billion towers in our community, yet we can't seem to allow people to get the care they need at an affordable rate.

Jason Dana Costa 5:57

No kidding. And are you organized as a corporation or $501? We're a corporation.

Roger Jansen 6:03

Okay. Yeah, we do have a 501c3 attached to us. So we provide a lot of ketamine and stelic ganglion block treatments to people with PTSD, depression, and anxiety. And a lot of those folks are often not able to work, and so they can't afford it. So we have a side of the house that helps cover that cost.

Jason Dana Costa 6:23

No kidding. So you're also helping the underinsured or uninsured as well. Wow, Roger, what an amazing model.

Roger Jansen 6:30

Yeah, well, I was in the big systems for a long time, and they get caught up in thinking you're doing the right thing and you're gonna have coordinated, integrated care. And what it really becomes down to is the consolidation of the health systems has really hurt communities. And prices continue to go up and quality and experience and access continues to go down, despite all their marketing dollars, despite all the effort they put in to host events and fundraisers. They pay their executives tens of millions of dollars to really not produce a product that's working for the communities that they're in. And it just doesn't seem right. So I'm in my mid to late 50s, and the goal was let's see if we can make a change before we hang it up. And if we can't, let's start it and see if others can pick it up as we move off the court.

Jason Dana Costa 7:15

Wow, that's uh that's really an amazing story, Roger. Really amazing. How do you connect that to your initial comment about your passion for research if you're really providing I'm gonna say primary care, but maybe it's not the right phrasing for it?

Roger Jansen 7:29

I'd like to use that research to make sure that we're bringing the best treatment modalities to the patients we serve versus those that are reimbursed by a CPT code. And so a lot of people perform unnecessary procedures. You go to an orthopod and they take your blood pressure and your weight and your temperature. Why do they do that? So they can charge a wellness code. It doesn't have anything to do with your sprained ankle, and they're not gonna fix your sprained ankle. So I think those are the things that we're really taking a look at is how do we make sure our research doesn't just provide care, provides maybe the U.S. isn't leading in this space, but maybe what they're doing in Portugal or Switzerland or wherever it may be is showing better outcomes in the way that we approach it. Let's do the research and make sure that we look at all that data.

Jason Dana Costa 8:12

And are were you there at the startup of this?

Roger Jansen 8:15

Say that again.

Jason Dana Costa 8:16

Were you this there at the startup of Exponential Health?

Roger Jansen 8:19

Yeah, yeah. I'm one of the founders. Yeah.

Jason Dana Costa 8:21

No kidding.

Roger Jansen 8:22

Yeah.

Jason Dana Costa 8:23

So, really, one of the questions I was curious to ask you, what was the defining moment for you that made you realize that this is a great way to improve health care from the traditional system that clearly wasn't working? You've intimated that, but what was that sort of aha moment?

Roger Jansen 8:38

I go back to the values I was raised with. Like you take care of others, and you don't get into a helping profession without literally wanting to help people. And if people can't afford what you're trying to help them with, then you can't help. And so we've created a system that's unaffordable, yet puts up more administrative roles and IT roles and accounting roles. And I often would say hospitals are IT companies that employ physicians because there's a lot of people in IT and accounting and that more than there are actually doing the care. And yet we've got nurses making 60,000, 70,000, 80,000 a year, and the CEOs are making four and a half, five, six million dollars a year who've never seen a patient, never changed a life. And I think we've got the system upside down. I often tell people don't go to the Lakers game and in the day to see the bus family. They went to see Matt Johnson or they went to see Kobe Bryan or Shaquille O'Neal or whoever's there now. And sometimes we think management's what's important, but it's all about the patient and it's all about the provider. And we've lost that in healthcare. And we've made it a corporate entity that operates under the veil of a not-for-profit, all while not giving any money back to the communities that they're in from a tax base. So there's nothing going to the education system, to the fire departments, to the police departments, to the water and sewage, to the roads. It's all being held internal. And we've got to start calling BS on it. It's just, it's time that we actually start taking care of each other again in this country.

Jason Dana Costa 10:03

Oh, love that statement. Absolutely love that. So clearly, you've built startups. And right now you're working inside the massive problem of healthcare systems. Where did you see where mission and money work together well? And where do you see that they've collided where clearly you're trying to break this?

Roger Jansen 10:20

You know, let's look at the U.S. economy right now. If you took all the money we spent in education and all the money we spent in the military, and those are big budgets, and we added those up and we times them by two, you still wouldn't get what we spend in this country on healthcare a year. So just let that think sink in. If you took all the legal profession and added it all up, you would not be able to pay what we pay our health care administrators in this country. So that's every attorney in every profession. They still don't make what we're paying our hospital leaders. So when you say, how do you get money admission to work? There is a ton of money out there. It just is being allocated poorly or improperly. And so it's really about the real allocation of funds to ensure that people can still make a good living. But should we really pay a hospital CEO who was really the equivalent of a superintendent back in the 80s and 90s, now the corporate equivalent of running PepsiCo? I don't think so. And part of that comes back to what are your values? And am I really worth $6 million a year? Am I is what I'm doing. And you can begin to justify that. But at the end of the day, are you making care more affordable, more accessible, better outcomes? Are you taking care of those who need it the most? And I think the answer would have to be no. And when you say you're giving all this charity care back, you're basing those prices off your charge master, which is just a fictitious number you can make up and you can call it anything you want, and then say we gave 50 million in free care. So again, I think this is about what is the passion? Passion is just about helping people. How do we do that better? If everyone walked into every job they had and said, look, it's not always about me, it's about what I can do to help others, we probably wouldn't be sitting where we are today. And that's just not the value set that myself or hopefully my kids and my family have, and certainly wasn't the way I was raised.

Jason Dana Costa 12:09

Give me a sense of scale. How much impact is exponential health having right now?

Roger Jansen 12:15

So, right now, across employers, we take care of about 15,000 independent lives. So it's small, relatively speaking, but it's making a difference.

Jason Dana Costa 12:25

But it's still bigger than I expected you to say.

Roger Jansen 12:26

Yeah, so it's making a difference for those 15,000. Obviously, we want to continue to take care of more and more people, but it's a journey and it's gonna be it'll go on long after I'm gone. But we are trying to make a model that's scalable throughout the country and replicable that people can say, hey, there's a better way of delivering healthcare than the way we're getting it today.

Jason Dana Costa 12:46

And you know, I know you spoke about technology a little while ago. Is there things about how you're utilizing technology when you're rethinking this model now that maybe traditional healthcare really hasn't been looking at?

Roger Jansen 12:58

I mean, technology is a really broad term. So what I guess I would say is looking at treatments and what really is effective versus what isn't. Like there are certain procedures that were approved in the 80s and make the hospitals a lot of money because they're inpatient that could be done completely differently now on an outpatient basis that just aren't done. There's things like that we're trying to utilize and make sure that we're bringing in. There's treatments for effective and mood disorders, whether it's PTSD or depression or anxiety or what it may be, that insurance companies don't reimburse for, but we're giving meds that were popularized in the 70s and 80s still today, with a little bit of a twist on them that have very little effect, but cause people to lose their libido, gain weight, be more blunt affect, and then we keep them on them forever. And those don't pretend the best outcomes. So it's those types of things when I mean technology and that we're really looking at from an AI perspective. We're no different probably than anybody else out there from we're not a tech shop.

Jason Dana Costa 13:54

Got it. But really, you're trying to look at effective clinical ROI, really. That's what I'm hearing you say.

Roger Jansen 14:01

Yeah, I mean, here's a crazy idea, right? Let's do the stuff that actually works, doesn't cost more. And so we don't charge per procedure, we charge a flat monthly rate for our services. And you can come and see us as often as you want. There's no additional charges. You need a pap smear and physical and mole remove, whatever it may be. You don't get charged for that. There's no additional codes. It's literally like buying every other product. When I go to the gas station, I don't like the prices of the pump right now, but at least I know what the price is. When you get a knee surgery, you have no clue. And then you get a bill 12 months later for the surgery that was done 12 months earlier, and you don't even know what half of it's for. And the system's so complex to navigate, people just give up. They just say, I'll just pay it.

Jason Dana Costa 14:40

Is all of the doctors in-house? Is everybody sort of with you in there, or are you contracting out?

Roger Jansen 14:46

So we don't employ all of our physicians. We have 51 independent groups that we work with. They've agreed to kind of work under these terms and conditions as well with our network.

Jason Dana Costa 14:54

So is there anything that you had to help them sort of unlearn about what they're used to because this is sound so fundamentally different?

Roger Jansen 15:02

No, they still do the traditional models, but they still work with us as well. So they kind of have a hybrid. But yeah, they've been great. And again, not everybody wants to join because if I can just my first training, I remember my first department of neurology meeting, I raised my hand and I said, So if I find more wrong with patients, we can charge them more. And somebody said, Well, yeah, I'm like, well, you know how easy it is to find something wrong or we should test for? I mean, that can be done all day. And that's the model we're operating in, right? Hey, I should do a stent because I bought a new cottage. And people want to say, Oh, people don't do that. No, people do that. And when you look at the amount of people employed by healthcare, the same issues and ills you have in the general society are the same ills and issues you have in healthcare. And putting people on a pedestal because they have the term doctor or this or that doesn't change their moral or ethical guidelines. And it really is a shame that we've let this get out of control. So a lot of people can make a lot of money off the very few.

Jason Dana Costa 16:01

Boy, as a nonprofit professional, my entire career, frankly, that just resonates with my heart so much. That's fantastic to hear. So I was curious, given that you've you've brought this organization from idea to something, clearly, 15,000 people of care, and you're also a psychologist and a clinician, uh I'm because of course that means you're an expert on human behavior. What about human behavior? It sort of taught you about leadership and growing this organization that maybe business school would never have shown you because that's what my expertise is. I'm a businessman by grade.

Roger Jansen 16:34

Yeah, I mean, I think for me it comes down to three things people, place, and purpose. If you don't get the right people, game over. You have the best playbook around, but you're not going to execute the plays that you want to execute. Place people who've got and want to be associated with coming to work every day and feel like they're motivated to be a part of it, which is driven by the purpose that they have. And so everything that you look at on an Excel spreadsheet, your eBid on margins, what's your gross profit, what's your cost of goods, all these things, those are important 100%. But the intangibles, the culture, the belief system, do we get along? Are there power struggles? Do we have the ability to question authority? Are those things in play? Because if those aren't present, then you're gonna probably have an organization that doesn't operate and function really well. And so when I look at leading an organization, there's two things that I need people to be a part of. Do you buy into the vision? Do you believe in what we're doing? Because if you don't believe in where we're going, then you're not gonna be any good to me and the organization are getting to where we need to get. So you need to buy into that. And then the second thing is there's something more important than your own success. And if you don't believe there's something more important than your own personal success, then it's gonna be difficult to be the best provider you can be because that patient should be. It's gonna be difficult to take care of employers because their bottom line should be. And we just need to think differently about things. And it's not rocket science. I've got a presentation I put together. It's not rocket science because it comes back to actually just doing the right things the right way and having intent that's not always playing some game and some angle. Healthcare's got an angle on everything. These executives, and I was a part of those teams, right? I was a C-suite member at one of the largest health systems in the country. And just the way that you think about that is warped when you're inside of it because you are caught up in the culture that you're a part of there. But when you step out and actually talk to the businesses and talk to the employees and talk to the people who can't afford it, you really have meaningful conversations. You're like, man, we're doing this the wrong way. This is actually not helping the community. If we really wanted to help the community as much as we could, we shouldn't put a $1.7 billion up. We should invest $400 million of that in healthy food for the community in perpetuity, another million or billion dollars of that into affordable housing for the community, and then take another $300 million and put it in the best mental health network you could ever find so we can stave off stress, all these things, and take that $1.7 billion and get rid of that tower, right? But that's not the way we think. We think about more butts and beds and more codes we could build.

Jason Dana Costa 19:23

So who was the mentor or leader that really made you think about this trust culture and clearly taking on a difficult challenge like this? Tell me who this person that inspired you to be so.

Roger Jansen 19:34

I mean, I don't think there's any one individual. Even people I've worked with in the health system have a ton of respect for. My former boss and CEO, Rick Brian, was a great person and probably affected me and how he thought about healthcare in a lot of different ways. Dick Hayworth, who owns Hayworth Manufacturing Furniture Company, his qualities, his interpersonal demeanor, his focus on family-owned and taking care of his people was a tremendous impact on me. And then I go back to the biggest leader of my life is my mother. And just, hey, remember you're not here for yourself, kid. Like there's other people around, you got to think about them and take care of them. And I don't care how old you are, you want to make sure you're doing right by those lessons you learned as a kid.

Jason Dana Costa 20:15

Oh, yeah, absolutely. My dad's always in the back of my mind. As I said to you before, we were online here. He passed away a few years ago. When I asked him at the time, what do you want to be remembered by? If there are three words you want to be thought of, and without even a snap of a second, he said, I just want to be remembered for being a good man. Three simple words. A good man.

Roger Jansen 20:35

Yeah. I mean, I watched people have a lot. And I I grew up with limited means, and I think the best times of my life, outside of my kids and my wife and those things, they're when I didn't have anything. Um and didn't know I didn't have anything. And I was okay with it. And I was okay with it. You know, it comes back. You give me a tennis court, a basketball court, some people to hang out with, I'm a pretty happy guy.

Jason Dana Costa 21:00

That's good to hear. Yeah, I heard the basketball reference, and we talked about tennis earlier, so clearly those are passions for you. So in our careers, we all have difficult seasons as well. So I was also curious to ask what sort of challenge did you run into that really changed you personally or made you a different leader after that experience?

Roger Jansen 21:20

That's a really good question. I think I lost a team member to suicide. Oh, wow. And they weren't a direct report, they were one step removed. And I'll never forget the day I was informed that they had taken their life. And it reminded me significantly of the importance we have of understanding people for who they are and not just the title that we have inside an organization. And that everybody is somebody else's daughter and mother and sister and best friend, and they're not just the marketing director or the HR leader or whatever it may be, and that we have to take the Whole person to account at work. And when people say it's just business, I call it's just bullshit. If you can separate being a person and being just in business, we call that disorder schizophrenia. And so you're living two distinct lives and they're not real. We bring the whole person to work. And I think that was a moment that made me realize we need to pay better attention to how people are doing. And we got to make sure that we're thinking about their mental health and their physical well-being, more than just did they get the project and excel back to me and the PowerPoint templates ready to go. And so I think that's affected my worldview of how we think about what does it mean to take time. So we have an unlimited time off mantra at our place. We provide our services to our employees and their families at discounted rate 50% off to make sure that if they're having a mental health issue or a back pain or they need some type of med or they need some type of injection of some sort, that we can provide that. And we extend that pretty deeply. So I think unfortunately it was a pretty sad case of losing a team member that I think really shaped and reset because I'm a pretty hard-driving competitive person. And you sometimes need a reminder that you got to pause. You can't hit the rewind button, you can't hit the fast forward, but you can pause and reflect and can we do these things differently?

Jason Dana Costa 23:18

What a powerful story, Roger. I mean, first my condolences. Losing anybody in your sphere is always challenging. But I think you've taken away an excellent lesson that your colleagues at Exponential Health and all those around you must be greatly benefiting from. What a great challenging story, but a good outcome to come from it. What a great way to think about it. When I'm orienting our organization, I typically try to make sure people are I call it Coster Incorporated. I don't mind if people are growing within our organization. That's great. I don't mind with people are growing through our organization if they have another great place to go through. Welcome when they come in, welcome them and respect them when they leave and all those things, because it is the whole person. Frankly, it's what drew me to nonprofits away back when I could have probably worked for Fidelity and had some large house and a home, but I was far more interested in doing excellent work for people, uh, you know, and making the world a better place because I was part of it. 100%. 100%.

Roger Jansen 24:21

Yeah, and kind of related to that, I'd say the other side is just looking at the brain and knowing that we're all told from a very young age that we're supposed to achieve and achieve. And the fruit of those achievements, the way we keep scores are bank accounts, and those bank accounts tell you what your worth is. And I think working around a lot of people who are not just millionaires, but billionaires, and understanding their lives and understanding there is a plateau that your brain can reach in happiness, right? There just is. You can't be in a manic state 24-7 and actually be healthy. So we all have levels and baselines of how happy we can get and how sad we can get, and just recognizing that money is not the answer. And it's all about relationships. And the relationships we try to cultivate here is taking care of people and being transparent with people about what we can and cannot do. And I think you come from, you know, in our field, we see a lot of pain, physical, psychological, emotional, economical, a lot of different forms of pain. And when you realize everyone's going through something, doesn't matter who you are and what your name is, we can all begin to be a little bit more empathetic and helpful because we all need, I mean, life's hard. It doesn't matter who you are, life is hard. And we need outreach and support more than what we often get. So that's part of what we try to extend here to our team members and to our patients.

Jason Dana Costa 25:49

A friend told me a phrase a long time ago that everybody's carrying an invisible backpack. You don't know what's in it.

Roger Jansen 25:54

Yep, 100%. Yeah. And we all think Facebook or fake book, as we should maybe call it, is what people are really going through, but it's just not. It's not real.

Jason Dana Costa 26:07

Oh, so powerful, Roger. I commend your experience in pivoting those things and really not only making an impactful change in the ecosystem of healthcare and how it's provided, but how it's provided even to your team. Because that kind of behavior is really worth the work. That's when you know you're making a real impact to your community, to your patients, and to your colleagues. I can't commend you enough. That's fantastic. It's inspirational, I should say.

Roger Jansen 26:37

Thank you. Yeah, we're trying. I mean, we're certainly not perfect, but we try. And I look at myself 15 years ago, and I was probably that high charging. Let's get it done, let's own everything and do everything. And everyone needs perspective, and sometimes they get that different ways at different times. So, and I think our outlook, as I say, it can be in the ocean. If you're just one or two degrees off, you're going to be end up in a very different destination than the ship was going that other one or two degrees. And I think that's where we've differed from our colleagues, if you will, in the healthcare space, is that we believe probably in a lot of the same things, but there is a few degrees of separation on some really important things that make us appear very different.

Jason Dana Costa 27:18

Well, Roger, that it's a powerful way to end our time together. I thank you so much for joining our podcast today. Our guest today has been Dr. Roger Jansen, who is leading, I think, an amazing organization as a CEO of Exponential Health. Thank you so much for joining us here, worth the work. Thank you very much for having me. Appreciate the time. Excellent.