For years, the rallying cry around health care was the need, want, desire to provide insurance to everyone.
It would solve so many problems, most said.
Barry Ostrowsky, the retiring CEO of RWJBarnabas Health, wasn’t one to agree.
Don’t be confused, Ostrowsky certainly favors insurance coverage for all — he just feels it’s not the cure-all some feel it will be. It is not, he said, the best defense in the battle to keep people healthy.
Ostrowsky was one of the first health care leaders in the state to bang the drum about the social determinants of health. He remains in that camp.
“I do think that it’s good to have health insurance, but, if your refrigerator is empty, you can forget about health insurance,” he said. “And, if the roof leaks, and the plumbing doesn’t work, who cares about health insurance?
“I think the issue really is: If you’re going to want people to live at the maximum level of personal satisfaction and enjoyment, you’re going to have to restructure how you support that — and it isn’t about giving everybody a health insurance card, it just isn’t.”
Under his leadership, RWJBarnabas Health has been a leader in improving the lives of residents battling food insecurity and housing problems, among a multitude of other issues. RWJBH programs have made a difference in the lives of many, keeping them out of health care facilities in the process.
“I truly believe the mission to make people healthy requires a social mission,” he said. “And, so, I attempted to create social programs that address the social determinants of bad health, and had those programs interact with the clinical programs.
“We have great clinical programs in New Jersey and we have great clinicians in New Jersey at every level of licensure — you couldn’t be more committed than the folks we have providing health care service. But all the great clinicians won’t make people healthier if they don’t have food, or if they live in substandard housing.”
Ostrowsky, a health care executive for more than 30 years and CEO for 10, said he lists this mission as the most impactful of his career.
“What I’m most proud about is that we’ve taken our organization and we’ve created programs to address the social determinants — not to put them ahead of clinical service, but to align them with clinical service,” he said. “If we ultimately get the opportunity to really interact with members of the community — and lay out a comprehensive life plan for members of the community that deals with all of both clinical and nonclinical, and provide infrastructure around social programs, which will be critical — we will have made a tremendous difference.
“That’s probably what I’m happiest about as I look back on my career.”
Ostrowsky recently spoke with ROI-NJ about all aspects of his career in health care — and the future of health care. Here’s a look at the conversation, edited for space and clarity.
ROI-NJ: Let’s stay on the idea of social determinants of health. Is the concept advancing as quickly as you would like?
Barry Ostrowsky: I think it’s picking up steam. It could always be done more quickly, and it could always be done more effectively. But I am happy that other organizations have adopted this, both locally and regionally and, to a certain extent, nationally. I am happy with the fact that this is no longer an unorthodox fascination — that this has now become more of a core to the reason that many of us are in business.
I only wish that the financial infrastructure existed that would allow us to expand more readily and more effectively. For the most part, you can’t bill a third-party health insurer for these social programs. And, to a great extent, government-funded health care is not interested in funding this. So, I think it’s been widely accepted that this is now both necessary and highly effective for the people who live in our communities, but we still haven’t figured out how to scale it, and how to effectively supportive financially. I think we’ll get there eventually, but we just haven’t done that yet.
ROI: There are a lot of people involved in this process — and I think it’s fair to say all of them still have room to grow in their roles. Talk about the challenges.
BO: The health care industry has been very bad at trying to be effectively persuasive to members of the public about how they can treat themselves better. We just haven’t found that magic language to get them activated.
I tell our people and have forever: When I was growing up, there was a public service campaign about not being a litter bug. We had to actually try to convince ourselves not to throw garbage on the street, which, by the way, we haven’t yet conquered. So, what’s the chance that we’re going to tell people to drop the pepperoni and eat the broccoli?
No one’s going to listen to that, unless for some reason, it’s motivated by a program or a piece of persuasion that I don’t think we’ve yet invented.
ROI: And then there’s personal responsibility.
BO: For years, patient responsibility was typically defined as an out-of-pocket copay. But the bigger patient responsibility is to treat yourself, your body and your behavioral health more effectively, and, in fact, pay attention to what you do that may be behavior that’s inimical to good health.
(Ostrowsky said the next generation brings hope.)
They’re very worried, perhaps more so than I was at a similar age, about the climate and about alternative fuels and the impact that it has on the planet. So, maybe part of that can be translated into how better to take care of yourself.
Let’s have less obesity and better health. Then, health insurance will plug the gap. If you, unfortunately, really get sick, it’ll pay for it. Health insurance itself won’t keep you well; you’re going to have to contribute in terms of personal behavior.
ROI: Let’s turn to another big issue in health: Consolidation of health care systems. You experienced this firsthand when Barnabas Health merged with Robert Wood Johnson Health in 2016 to become RWJBarnabas Health. Here’s the billion-dollar question: Are these mergers good for patient care and outcomes, the metric that matters most?
BO: I do believe in the systems, and I believe that there is a level of economic benefit. Consolidation should allow you to perform services more efficiently and consolidate the kind of administrative services that you have to have in order to maintain various venues. It also gives you the leverage to recruit and maintain better clinical staffs, buy the latest technology, invest in new techniques that will ultimately deliver better health care and give you better results. So, I think consolidation as a business technique, to get more out of invested capital and to better expand access to better products and service, is absolutely true. And, if managed correctly, I think it gets you to the results you want.
ROI: What’s the downside?
BO: The downside is that health care is a personal business. It is typically reflective of the demographics of a given community. And, when you build big systems, there is a tendency — and we have fought this, maybe not nearly as successfully as I would have liked — to try to have a system culture or to insist on doing things in a way that are the same.
The risk of doing that is that you can ignore the cultural competencies that you need to be most effective in different kinds of communities. I think a system should have cultural principles that are embraced and satisfied wherever you have a program or a facility, but I think you can’t allow those systemwide principles of consolidation to overtake local cultural requirements. The people that you’re treating don’t live at a system level, they live at a local level — and we have to acknowledge whatever cultural mores are most effective for them.
So, there is a balance that has to be struck. But, I think, as a business proposition, the increase in consolidation that has taken place over the last decade clearly has the potential to be far more helpful than harmful. And if you police this balance of local versus system, I think I think you can have the best of all worlds.
ROI: Let’s turn to ‘New Jersey vs. the world.’ Or maybe just New York City and Philadelphia. As you know, it has long been a rallying cry in New Jersey that you don’t have to leave the state to get top care. How close are we to that idea being universally accepted?
BO: I think it is closer to being around the corner than ever before. I think that we have made great strides in that regard.
It’s an interesting concept to look at. A lot of the care is delivered by highly specialized physicians. And the bigger training programs at these famous places produce a lot of top physicians who need jobs. So, the reason cancer services in places like New Jersey have erupted to greatness is the great cancer hospitals of decades ago have produced so many terrific subspecialists, all of whom are searching for positions where they can practice their craft. We actually have benefited from that.
In New Jersey, there always will be this sociology about going to the big health care centers, which are defined as Philadelphia, New York. But there are people from New York who go to Cleveland and Houston and Boston. So, not every jurisdiction, even the great places, keeps everybody at home. We’re going to get closer to that by speaking to the folks that live in New Jersey and getting them to better understand the availability of services here.
Here, too, is a generational issue. The current young generation, while they’ll study all of the data and make more informed decisions on basically everything from health care to appliance selection, they also like convenience. And, I think, if you can marry up the data on great clinical care with the convenience of staying local, we will make the turn around the bend and people will be staying here.
ROI: OK, last question. Simply put, what are you going to do when you retire at the end of the year?
BO: Well, initially, I want to search out boredom. I want to try to be bored. I really have always thought, whether it’s business or retirement, you need a glide path. So, I won’t know what the end result is of retirement for some period of time. I’ll decompress and will not have a calendar to which I have to pay homage. I won’t have the level of meetings, and I’ll get comfortable with that.
But, for me, it’s the idea of not having to be someplace or multiple places at the same time, which happens occasionally, will just be a godsend. And, from there, I’ll kind of build whatever metabolism I think best suits me. But I have to tell you, I really can’t wait. I’m excited about it.
Five fun questions
What is the most notable job you had in high school?
I grew up in a family business; we had a paint store. My entire employment career, prior to law school, was working in working in my father’s paint store. I started literally in the cellar, washing out jugs into which we put turpentine. So, when you talk about trying to work your way up, I started at the bottom — and I never really got much farther than that.
But, I will say this, I learned a lot about customer service growing up in a retail business. We closed at 6 o’clock. But, if someone called and said, ‘I’m running down for a gallon of paint, what time do you close?’ Our answer was: ‘We’ll be here until you get here.’
What skill do you use on your kids that you learned at work — or use at work that you learned from being a parent?
Having been married for 48 years, the No. 1 parenting technique I’ve used is the phrase, ‘Ask your mother.’ Between the two of us, I was the more of a pushover. So, no one came to me for discipline. And, as I got into health care management, no one came to me for discipline here, either. I always consider myself chief morale officer of the organization and let somebody else be the vice principal.
What person, dead or alive, real or created, famous or infamous, would you want to have dinner with?
My tastes tend to run tend to run to sports. And I had the good fortune of having multiple dinners with people like Mickey Mantle and Whitey Ford. So, without insulting someone more intellectual, I would very much like to have had dinner with Babe Ruth.
If you could be New Jersey business czar for the day, what would you do to help the state?
I would try to create whatever rule, regulation or enforceable policy that would require New Jersey businesses to have to do business with other New Jersey businesses. I’m convinced that we do not capitalize on the strengths of each other. And, if we actually focused on that, if we got together as a business community and tried to maximize the intra-New Jersey business community, the commerce activity that we could create would be 1+1 = 3 or 4.
I understand that there are all kinds of reasons to do business with the entities outside in New Jersey. But there isn’t anything we could not fix — and we would produce even more tax revenue that could be reinvested in pro-business opportunities — if we concentrated on maximizing commerce within the state with each other.
I’ve always thought, what if we went to McKinsey or some such consultant house and said: ‘What if the biggest businesses in this state concentrated on doing business with other businesses in the state? Give us an answer that would be directionally correct.’ If our current business community creates X billions of dollars of economic activity, what would happen if we did that? How much more economic activity for the state of New Jersey would be created? I really think there’s something there.
What is your favorite food? It can be a meal or a snack — or even a restaurant.
I’ve always said, you can pick either one, but, if they outlawed cheese or nuts, I’d be a rail. I’ve never met a cheese I don’t like — and I would say the same thing about nuts. Salted or otherwise, by the way.