JTBD based Strategy for Two-Lane Business Models (Healthcare)
JTBD Strategy : Two-Lane Business Models (Healthcare)
The Challenge (Healthcare)
“How do you create a person-centered healthcare company when the economic incentives (like Medicare reimbursement) don’t align with the true Jobs to Be Done (JTBD) of patients?”
In simpler terms:
Patients want life outcomes: independence, peace of mind, freedom from pain, staying connected to loved ones.
The system often pays only for transactions: office visits, procedures, hospital stays — not the full set of services or supports that would help patients achieve these outcomes.
This creates a fundamental tension between:
What matters to patients → holistic, integrated progress
What pays today → fragmented, volume-based, reimbursable activities
Why This Happens (Structural Forces)
Fee-for-service design → Pays for “what you do,” not “what you achieve.”
Regulatory silos → Medicare Parts A, B, D, and Medicaid all cover different slices of care; social and behavioral supports often fall outside.
Short-term incentives → Providers are rewarded for volume and compliance, not long-term patient progress.
Misaligned risk sharing → Few providers or plans take on full population risk, which would give them an economic reason to invest in upstream, nonclinical solutions.
Measurement gaps → Health systems track what’s billable, not necessarily what improves a patient’s life.
(1) Recognize the Two Games You’re Playing
Game 1 (Survival Game):
Play today’s incentives well enough to stay alive — even if they're imperfect.
(Example: Bill for reimbursable services, meet minimum compliance, etc.)
Game 2 (Progress Game):
Build tomorrow’s value system that aligns economic incentives with true JTBD (person-centered goals).
(Example: Outcomes-based contracts, alternative payment models, direct-to-consumer solutions.)
→ Person-centered companies play both games intentionally — without confusing them.
(2) Find the Overlaps first
Even if Medicare doesn’t reimburse for the full JTBD outcome, ask:
Are there elements of the job (or adjacent jobs) that are reimbursable?
Can partial progress be funded today while setting the stage for a larger solution?
Example:
If the JTBD is "maintain independence at home," and Medicare won’t pay for social services, but, it does pay for fall prevention screenings — use that as a funded wedge to build trust and start progress.
(3) Develop a Two-lane business model
Lane 1: What is funded today (even if imperfect).
Lane 2: What customers would pay for (or pay differently for) if framed around their true JTBD.
Lane 2 can include:
Direct-to-consumer offerings (cash-pay upgrades).
Employer contracts (if you improve productivity or retention).
Grants and philanthropy (for public health-aligned goals).
New partnerships (retail, community organizations).
Companies like ChenMed, Oak Street Health, and Cityblock Health pushed into Lane 2 by tying outcomes to savings, even when traditional billing didn't fully recognize it at first.
(4) Use JTBD Language Internally to reframe success (patient outcomes)
If you only talk about RVUs, CPT codes, or reimbursement rates, you train employees to think small and transactional.
Instead, define success internally as "Did we make real progress on the customer’s JTBD?"
Celebrate customer progress stories.
Highlight invisible wins (reduced loneliness, better confidence, better daily energy).
Train frontline teams to see the human outcome, even if the billing system ignores it.
Culture change starts here.
(5) advocate and prototype toward the future
Person-centered companies don’t just wait for incentives to change — they build early models that prove better outcomes, lower costs, or higher loyalty.
Run pilots that show economic value of solving the full JTBD.
Gather evidence for grants, payers, employers, or policymakers.
Prototype bundled services, cash-pay models, value-based care agreements.
Every great shift (e.g., value-based care, remote monitoring) started with small experiments proving the new model worked.
The Two-Lane Business Model (Healthcare)
A strategy that balances Lane 1 (what pays today) and Lane 2 (what patients actually need to make progress) — allowing the organization to survive financially while building toward a more person-centered, outcomes-driven future.
The Survival Game (Today’s Incentives)
Focus: What is reimbursed under current payment models (Medicare, Medicaid, commercial insurance, FFS)
Examples:
✅ Billable services — office visits, procedures, hospital stays
✅ Preventive care mandates — screenings, immunizations
✅ Care management fees in risk or value-based contractsOperating mindset:
→ Compliance, volume, documentation, and margin protectionOutcome measures:
→ Revenue, cost control, RVUs, billing efficiency, audit performance
The Progress Game (Patient JTBD & Future Value)
Focus: What actually helps patients achieve meaningful life outcomes, even if not fully reimbursed today
Examples:
✅ Care coordination, health coaching, and behavioral health
✅ Addressing social drivers (food, housing, transportation)
✅ Tech-enabled engagement (apps, remote monitoring, peer support)
✅ Cash-pay services, memberships, or philanthropic supportOperating mindset:
→ Innovation, experimentation, long-term relationship-buildingOutcome measures:
→ Functional outcomes, reduced hospital use, patient-reported outcomes, trust, and loyalty
Job Map (Survival Game) - Work within Medicare incentives
Overall Job: “Ensure we are financially sustainable under current Medicare rules and payments.”
Job Steps:
1. DEFINE: Identify billable services under Medicare Part A/B.
2. LOCATE: Check patient eligibility and benefits coverage.
3. PREPARE: Collect required documentation (e.g., prior auth, referrals).
4. CONFIRM: Verify coding and billing compliance.
5. EXECUTE: Deliver reimbursable care (e.g., office visits, procedures).
6. MONITOR: Track productivity metrics (RVUs, billed services).
7. MODIFY: Adjust service offerings to optimize for reimbursement.
8. CONCLUDE: Submit claims, resolve denials, close encounters.
9. FOLLOW-UP: Manage appeals, billing questions, revenue cycle follow-up.
✅ Mental model: Focus on compliance, volume, billing accuracy, and financial viability.
✅ Main success measure: Revenue capture, cost control, audit performance.
Job Map (Progress Game) — Align to person-centered JTBD
Overall Job:
“Help patients achieve meaningful life goals, regardless of reimbursement.”
Job Steps (Progress Game):
1. DEFINE: Understand patient’s life goals (e.g., stay independent, reduce pain, avoid hospitalization).
2. LOCATE: Identify social, behavioral, environmental barriers (e.g., transportation, food insecurity, loneliness).
3. PREPARE: Develop a holistic care plan beyond just clinical needs.
4. CONFIRM: Engage patient and family in setting shared goals.
5. EXECUTE: Deliver wraparound care: care coordination, home visits, coaching, social services referrals.
6. MONITOR: Track progress toward goals (e.g., mobility, quality of life, confidence).
7. MODIFY: Adjust care plan as needs change over time.
8. CONCLUDE: Celebrate progress, reinforce self-management skills.
9. FOLLOW-UP: Maintain long-term trust, check-ins, proactive outreach.
✅ Mental model: Focus on outcomes, relationships, life context, and empowerment.
✅ Main success measure: Patient progress, engagement, satisfaction, avoided crises.
Why This Challenge Matters
Without addressing this tension:
Patients experience fragmented, frustrating care.
Providers burn out from delivering “checklist medicine.”
Payers and society bear rising costs without improving health outcomes.
If you solve it:
You unlock a competitive advantage → loyalty, retention, market differentiation.
You create a mission-driven culture → employees feel proud, not drained.
You help bend the cost curve → doing well by doing good.
A two-lane business model lets you survive today while building the system you wish existed tomorrow.
Reach out at https://ChataboutCX.as.me/TalkCX if you wish to learn more.