We’re Looking at Healthcare All Wrong:

What you’ll learn:

There is so much discussion about the problems facing healthcare. And there are so many people and organizations responsible for pulling it in different directions. From the people responsible for delivering it, the people responsible for paying for it, to the individuals and families receiving it, there doesn't seem to be any consensus on what "good" looks like, and on how we define value within the system.

What is valuable is largely determined by perspective.

In We’re Looking at Healthcare All Wrong, John Guarino shares how decisions that are rational for each stakeholder can still produce unintended outcomes at the system level. Clinical benefit is real but interpreted differently depending on who bears risk. Economic impact exists but is often captured by someone other than the innovator. Experience matters to patients and clinicians, yet is rarely priced explicitly. Total cost is carried by payers, employers, and the government, often disconnected from where benefit shows up. Time horizons almost never align.

This series examines healthcare by changing seats and explores how structure shapes behavior, why accountability fractures across settings, and what it would take to move from stakeholder optimization to shared ownership of outcomes.

I interact with healthcare professionals who care deeply about doing the right thing all the time. Clinicians, administrators, payer leaders, industry teams—people who are thoughtful, experienced, and often frustrated. Over time, as I’ve watched these groups wrestle with the same problems from different angles, one pattern has become impossible to ignore: everyone touches the patient, but no one truly owns the outcome.

I see this most clearly when we map a patient’s journey. Care rarely happens in a single place or under a single decision-maker. A patient may move from primary care to the emergency department, into a hospital bed, then out to post-acute care and long-term management. Each transition introduces a new organization, a new contract, a new set of incentives.

When you ask stakeholders who is responsible for the outcome of that journey, the room usually gets quiet.

Clinical benefit, we quickly realize, is distributed. No single clinician or institution delivers “health.” Outcomes are produced across episodes, sites, and time. Each contributor is evaluated on a narrow slice, quality measures, utilization targets, and productivity metrics, rarely on the total result.

Costs Make Sense Locally and Fail Systemically

The same fragmentation applies to health economics. Costs incurred in one setting may prevent far greater costs elsewhere, but those savings often accrue to someone else. I’ve seen hospital leaders explain how reducing readmissions hurts fee-for-service revenue and how Healthcare Effectiveness Data and Information Set (HEDIS) incentives are relatively small compared to revenue and costs, so they are not very motivating. Payer leaders describe “investments” in prevention that won’t pay off before members’ churn. Employers fund benefits without controlling care delivery. And the government absorbs downstream costs tied to decisions made years earlier.

From each seat, the behavior makes sense. From the system level, it doesn’t.

Patients’ Experience Is Holistic, the System Is Transactional

Experience is even harder to pin down. Patients experience care as a single story. The system manages it as a series of transactions, but systems experience population health issues. When access is delayed or denied, when handoffs fail, when patients feel lost, no one organization fully owns that experience. Each stakeholder can point to the part they did well, and they’re usually right.

Total cost, meanwhile, accumulates quietly. It doesn’t sit cleanly on any one balance sheet. We manage costs locally, department by department, contract by contract, while system-wide spending continues to rise. No one wakes up intending to drive the total cost higher. It happens because no one is accountable for it in full.

The time horizon compounds the problem. Health outcomes unfold over years. Budgets reset annually. Leaders rotate roles. Contracts expire. Accountability windows are short; health is not.

What I’ve learned from observing this system is that the problem is not a lack of intelligence or commitment. It is that we have built a system that rewards local optimization and hopes it adds up to system performance.

It rarely does.

When outcomes disappoint or costs escalate, the instinct is to look for bad actors. But when I stop and ask, “Did that decision make sense at the time?”, the answer is almost always yes. The misalignment is structural, not moral.

What Alignment Actually Requires

That’s why I’m cautious when people talk about “fixing” healthcare. The system is responding exactly as it was designed to respond.

Alignment, in my experience, starts when we stop pretending that optimizing our own slice will somehow produce collective success. Shared metrics matter, especially those that span settings and time. So does governance that brings stakeholders together to make tradeoffs explicit, rather than invisible.

Most of all, it requires acknowledging an uncomfortable truth: if everyone touches the patient, then outcomes are a shared responsibility, even if accountability has not yet caught up.

Until we design for that reality, we will keep producing results that surprise us, frustrate us, and feel inevitable only in hindsight.

Klick Health is the world’s largest independent commercialization partner for life sciences and a leading full-service pharma marketing partner, serving as agency of record for leading pharma, biotech, and healthcare brands. Klick’s specialized offerings are rooted in deep medical and scientific understanding, including market insights, award-winning creative, and proprietary AI and data models to craft impactful brand narratives and seamless customer journeys. Backed by nearly 250 medical experts and advanced healthcare analytics, Klick delivers integrated marketing strategy and communications, from new product launch strategy to MLR review with real-world evidence, helping brands thrive in today’s complex healthcare landscape. Learn more at Klick.com.