Culture of innovation. For healthcare to move forward, we need to be fostering innovation from the bottom up. Employees should be encouraged to find new solutions, rather than being relegated to the status quo. Take prior authorizations, for example. This antiquated process is costing time and money at every level of healthcare — but there are ways to modernize it, like electronic prior authorizations and real-time benefit checks, if organizations are willing to find, create, or implement them.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Jason Borschow. Jason is the President & CEO of Abarca, a pharmacy benefit management company with an entirely different approach to business and technology, and a corporate culture unlike any other in the industry.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
I grew up in and around the healthcare business. My grandfather founded Borschow Drug, a medical supply company in Puerto Rico, in 1951, and it remained in our family until about ten years ago. I started working there while I was still in school and began to see opportunities to improve the healthcare experience. I also came to know many of the people who would shape my journey to reimagine the drug supply chain.
By the time I graduated from college, I was focused on finding a better approach to some of the challenges in our healthcare system. So, I founded Abarca, a full-service PBM, and technology company, to challenge the status quo and make healthcare awesome for people across the US.
Can you share the most interesting story that happened to you since you began leading your company?
Honestly, I think we are on the brink of the most exciting time in the history of the PBM industry.
Policymakers, the media, and people across healthcare have been challenging the PBM industry. Rightfully so. This is not an industry known for transparent and straightforward businesses practices, and scrutiny is leading to significant and rapid changes in policies and the marketplace. And while not all of the changes have been entirely thought out, we think, ultimately, they will lead to more confidence in PBMs — who play a critical role in healthcare.
Some executives get nervous when their industry is in the spotlight — especially when it is for the wrong reasons — but what we see today is actually a healthy evolution. Abarca was founded to disrupt the PBM status quo, and to find a better way to deliver healthcare, and that is precisely what is happening.
Can you tell our readers a bit about why you are an authority in the healthcare field?
I think of myself not as much as an authority in healthcare as someone balances real experience working in the guts of healthcare with a willingness to do things differently. I see what is broken in the system, and I am driven to change it. It often isn’t always the most profitable or popular path, but I feel I have an opportunity and a responsibility to do something for the people who depend on the healthcare system, yet have no voice in how it works.
The healthcare industry is complex and continually changing. However, because of my background, family history, and personal interest, I do have a pretty good understanding of the business, and that always helps.
What makes your company stand out? Can you share a story?
Abarca is a different kind of PBM, and that all starts with a corporate culture that is unexpected for a healthcare company. Our organization was founded upon six core values that are fundamental to everything we do, from how we make business decisions to how all 300+ of us treat one another.
The importance of our culture has never been more apparent than when Hurricane Maria hit Puerto Rico. Abarca is headquartered in San Juan and serves people across the nation, including over a million on the Island. The entire company came together to support each other and ensure that our members were able to access their medications. Although many Abarcans lost power — or their homes altogether — we were able to deploy teams across Puerto Rico to help pharmacies in some of the most devastated areas process claims. And not a single client — on the island or the mainland — experienced system downtime.
We’ve had many successes since founding Abarca more than a decade ago, but this was my proudest moment.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
Every day, we try to bring new thinking to many of healthcare’s long-standing problems. For example, we developed a PBM platform — that’s the engine that, among other things, helps people access their prescription benefits at the pharmacy — from scratch to be smart, user-friendly, and powerful.
The technology in our industry is, for the most part, from another era. Even some of the larger companies rely on slow, inefficient, and frustrating legacy systems that are being held together by years of patches and fixes.
When we launched our platform, which we call Darwin, the response was enthusiastic. Today, in addition to using it to serve our clients, we are also making Darwin available to other PBMs — aka our competitors. Sure, it is a little unexpected to provide proprietary tools to the competition, but we believe it is good for the healthcare system and the right thing to do. Consequently, over time, we also think it will be good for our business.
What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)
- The best talent can come from unexpected places. When you work in a niche business, it is easy to think that you should only hire people with industry experience — but that can be limiting. When evaluating a potential employee, I believe that how well a candidate fits their role carries more weight than where they cut their teeth. Abarca is in the process of hiring about 100 new team members, and our ideal candidates are from outside of healthcare. We want people who are passionate about their profession and can bring new perspectives to help us push our company beyond the traditional confines of a PBM.
- It can be intimidating to be the first. Finding new ways to approach long-standing business practices can sometimes feel like going on a road trip without a map — which can be as scary as it is exciting. Often, you have more of a reference for what you don’t want to do, versus what you want to achieve. When we were building Darwin, for example, we didn’t have an existing platform that we wanted to emulate or evolve, so it was up to us to determine what capabilities we needed, and how to build them. We could not be prouder of what we created, but it certainly wasn’t the most natural available path.
- Your brand has to match your mission. Deciding the visual identity of your brand can be one of the most intimidating parts of building a company, and the fear of making the wrong choice can steer you entirely off course. However, I’ve learned that so long as the look is true to who you are as an organization, there is no wrong direction. A few years ago, we realized that Abarca had evolved beyond our existing look and feel. So, we underwent a total rebrand to make sure that we are always leaving the right impression.
- There is no one way to lead. Being a leader, especially the leader of a rapidly growing company, is a massive responsibility. Too often, I have seen good leaders get so wrapped up in defining their style, or aligning themselves with a particular method, that they fall out of touch with their team and their objectives. To be an effective leader, you have to be able to adapt based on your organization, team, and task at hand. Abarca has very distinct technology and healthcare services divisions, and the way that these groups operate are by no means the same. So, my senior team and I need to be able to be flexible and implement the methods that work best for the project in front of us.
- Always be prepared. There is no way to predict when a catastrophe will strike — whether it be a natural disaster, a data breach, or something else entirely. That’s why it was so important to foster a culture of preparedness in your organization. At Abarca, our team undergoes regular disaster drills. Our data is cloud-based and redundant, and our call centers and critical personnel are strategically placed throughout the country. And we have communication systems in place to make sure that our members and employees can always reach us.
Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
First and foremost, I think many healthcare entities have lost sight of whom they are actually working for. Quite frankly, the industry has gotten greedy — just look at what’s happening with biosimilars. Patients now have a more affordable treatment option, but competing manufacturers are actively making it difficult for them to actually receive these medications because they fear the impact it will have on their business. This kind of behavior is not only childish, but it could have dangerous consequences.
Second, our technology is lagging. The tools we are giving our teams aren’t sufficient to allow them to do their jobs, so not only is there a lack of morale across the industry, but providers, pharmacists, and members are experiencing the brunt of the fallout. We need to be developing modern technology that provides a better experience for users and gives members greater access to their care. Moreover, that’s not even taking into account the technological progress needed to better protect patients against data breaches and other privacy issues.
Finally, the culture of our industry is traditional, at best. With some notable exceptions, too many companies in this space are slow-moving, risk-averse, and stifling to innovation. There are so few organizations who have corporate cultures corporate that inspires their employees to improve upon the status quo in meaningful ways, further perpetuating these cycles of dysfunction. And we all suffer the consequences.
You are a “healthcare insider.” If you had the power to make a change, can you share five changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
- Modern technology for core operations. We need to start building technology that will not only improve healthcare today but support the innovations of tomorrow. AI is emerging as a powerful tool for streamlining decision making and improving health outcomes. Value-based models require meaningful analytics and real-time information to succeed. The future of healthcare technology is here, and it is our job to leverage it for the most critical parts of the system and continue to improve every day.
- Better consumer experience. At the end of the day, healthcare is all about humans. They are the ones experiencing symptoms, taking prescriptions, and paying the bills, so we need to be giving them an experience that takes into account how personal our industry is, and make it work for them. For example, giving them real-time access to their medical information so they can make informed decisions about their care.
- Culture of innovation. For healthcare to move forward, we need to be fostering innovation from the bottom up. Employees should be encouraged to find new solutions, rather than being relegated to the status quo. Take prior authorizations, for example. This antiquated process is costing time and money at every level of healthcare — but there are ways to modernize it, like electronic prior authorizations and real-time benefit checks, if organizations are willing to find, create, or implement them.
- Responsible drug pricing. Self-serving business practices across healthcare have left consumers with a big bill to pay — literally. The nation is watching, especially now that the Trump Administration has mandated that drug makers include prices in their commercials. We need to be working together to price medications at a rate that we are proud to share in prime time.
- True transparency. It shouldn’t be breaking news when a PBM vows to pass through 100% of their rebates to members, but it is. It’s time for PBMs to put their money where their mouth is and actually operate with true transparency even when it may be a risk for financial outcomes.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities, and leaders do to help?
Change in our industry is going to be driven by individuals. Employees need to voice what they want in their workplace. Consumers and members need to question what they have been given and ask for what they want. They need to vote with their feet and their pocketbooks.
These voices are what is going to move healthcare forward. They are going to force companies to step up and deliver at a level that is beyond anything we have seen before.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
Early in my career, someone shared the famous Peter Drucker quote, “culture eats strategy for breakfast,” and that has really stuck with me. Peter Drucker was a heralded business thinker and management expert, and in his books, Mr. Drucker challenges executives to throw out conventional thinking, and create new strategies to advance their business. That lesson, in particular, has shaped my approach to healthcare.
I have also been fortunate to get to know Anthony Iannarino, an author and sales leader, whose books and podcasts have been an inspiration as we continue to expand our footprint in the mainland US. We were even fortunate enough to have Anthony lead a few Abarca events. Anthony offers several resources that are geared towards helping a company find, and succeed with, their own unique approach.
However, really what motivates me to be a better healthcare leader is people. Whether it’s members, employees, clients, partners, or consultants, I believe that everyone has a unique value to add — and often it is these perspectives that serve as the inspiration for Abarca’s solutions and services.
How can our readers follow you on social media?
I am on Twitter (@jasonborschow) and LinkedIn. Abarca is also on both of those platforms, and Facebook too, under the user name “Abarca Health.”
Thank you so much for these insights! This was so inspiring!