Salus Health Care Forum: November 5, 2025

The National Academy report is a deficit approach. They focus on what’s wrong. Let’s fix it. What are the problems? Let’s point them out and overcome them. Rather than what’s working, let’s do more of it. Rich just talked about a little walking program in a little town that changed the construct in that community. It was an asset-based approach. It wasn’t what’s wrong here? It was, hey, we can walk in the streets. Let’s do that. Let’s do more of that. And I think there is a real disconnect that I just want to point out and think about as we do our work. How do we think more about the assets?

I love this recommendation that they put in there. Let’s shift from low value to high value. And nowhere in that sentence or that paragraph do they talk about profit margin. And they somehow think that we can magically change the market from low-value care to high-value care without talking about shareholders. And Medicare Advantage profit. After all the bills were paid, there was $50 billion on the table that went to shareholders. That was $50 billion that was withheld from health care.

But there’s this construct that we use in American health care and insurance called the medical loss ratio.  Are you all familiar with the medical loss ratio? It’s an insurance term. The medical loss ratio is the amount of insurance dollars spent on health care. That’s considered a loss. So, for insurance executives, spending money on patients is considered a medical loss. Now, when I was at the health co-op, as part of the Obamacare group, we changed our language to medical benefit ratio. And we spent the two and a half years that the co-ops were in existence trying to infuse the concept of medical benefit ration into the insurance world. And more than that, into the policy world. Your medical benefit ratio needs to be 85%. 85% of the dollars brought in by revenue from an insurance company need to be spent on benefits. It’s not a loss.

Jeremy

I’m glad to see that this has triggered what I’m hearing from you, Jack.  I think Bill Bergquist will appreciate this. Jack, you have offered an appreciative inquiry approach that’s really asking questions and appreciating the assets that are present and how to augment what’s working. That was a powerful, compelling statement you made.

Bill B

Back to what Rich was talking about when he noted that they got the walking wellness model from the Hopi. This is a wonderful example of appreciating and appropriating an innovative practice from another culture. I’ve done a whole series of interviews with a physician colleague of mine who is 94 years old. He has spent time with the Navajo, with the Chippewa, with the Sioux, and several other groups. He talked about the rich learning he gained from his work in these communities. So Rich, I love the fact that you brought in an appreciative model. This means appreciating the wisdom, strength and successes of communities that we usually just ignore or we discount as being primitive or different from us.