Unlocking Value in US Health Care

This week on Quality Matters, we dive into a complex discussion on the often perplexing landscape of the health care economy with guest Sanjula Jain, Chief Research Officer at Trilliant Health. This isn’t your standard health policy chat; it’s a bold exploration of how costs, value, and quality intersect—and often misalign—in America’s health care system. Sanjula challenges us to rethink buzzwords like "value-based care" and "value for money," peeling back the layers to reveal stark realities behind these terms. Is our system delivering what we pay for, or are we caught in an unsustainable loop of rising costs and stagnant outcomes? The answers may surprise you. Sanjula combines sharp analysis with relatable analogies. Her insights into the difference between maximizing and optimizing value—and why the latter could save the health economy—offer a framework for health care enterprises seeking competitive advantage in a negative-sum game. The episode also spotlights the human element of health care economics, from patients delaying care due to unaffordable costs, to the flawed assumption that higher prices mean better outcomes. Sanjula doesn’t mince words: The current system is failing and incremental policy tweaks aren’t cutting it. But her optimism shines through as she calls on employers, voters and innovative thinkers to drive change. Key Quote: “Think about the airline industry and retailing, large consumer brands. They're constantly having to think about value and there ends up being fewer players. It's going to be interesting to see who is up for competing. Those who don't figure out a way to change their approach are going to be at a disadvantage. Nobody wants to say, “You are going to fail.” No one likes to talk about the bad things coming our way. But I view it as a warning. Hopefully some players are starting to think differently and understand nuances of their markets and how they can optimize. Because the optimization equation is going to look different for everybody.” -Sanjula Jain Time Stamps: (02:05) Understanding Health Care Costs and Value (03:51) Value for Money vs. Value-Based Care (06:20) Optimizing vs. Maximizing Value (11:10) What Most People Get Wrong About Value (13:24) Quality Measurement and Digital Solutions Links: NCQA on Value-Based Care Connect with Sanjula Jain