This is Laura Dirda with the Becker's Healthcare
podcast. I'm thrilled today to be joined by
Sentu Aramugam,
who's a chief commercial officer at ScanHealth Plan.
Sentu, it's a pleasure to have you on
the podcast today. Thank you. Really happy to
be here. Now I'm excited for our conversation
because I know you've got so many great
things happening there at Scan Health Plan and
truly are at the forefront of many invasions
in health care and really,
making sure that populations are covered in in
a great way. But before we dive into
that, I was wondering, can you tell us
a little bit more about yourself and your
background?
Yeah. I'd be happy to.
So as you said, I'm the chief commercial
officer here at Scan,
and I'm accountable in that regard for our
sales,
our product, and our marketing organizations,
across the enterprise.
Prior to SCAN,
I was a partner at McKinsey and Company
in their health care practice. I worked with
Medicare Advantage Plans and academic medical centers across
the country on
growth strategy,
operations, turnarounds,
and transformations.
It's amazing to hear. You know? And and
what a a great way to,
unfold your career, especially in ways that are
impacting,
people across the country. Now from your perspective,
what are some of the biggest issues that
you're following in health care right now?
That's a that's a big question. There's a
lot unfolding right now,
as you know, Laura, and a lot of
uncertainty in the in the market.
With that said, I'll I'll hit a few
things on my mind. First, of course, the
final notice,
especially being the middle of mid season,
we're tracking this very closely, as you can
imagine.
We're hoping that there's some relief, particularly in
the revenue compression that was foreshadowed,
in the mass notice, especially in the part
d side. So that's that's definitely top of
mind.
Second, I'd say we're really tracking very closely
this idea of disruption driven shopping, and this
is a really big one.
With the revenue compression that we have seen
in the industry combined with the stars downgrades
that a lot of carriers have been exposed
to over the last twelve months,
it's causing a lot of MA plans to
really scale back. And not just MA plans,
provider systems as well, just exiting MA,
and that's causing really severe access issues for
MA members. You know, this year, I think
the stat that I'd seen
was something to the effect that there's going
to be almost 2,000,000
folks who will be having choose a new
MA plan because of a disruption event.
And that's really just unprecedented in scale. And
so, you know, at SCAN, plan stability, benefit
stability, something so
fundamentally important to us.
We see ourselves
in a real prime position to serve the
members that are gonna be impacted by these
these disruptions.
Absolutely. That makes a lot of sense. You
know, it's been fascinating to see that evolution
of those MA plans. And then as you
mentioned, you know, a lot of the disruption,
especially over the last twelve months or so.
You know, and so when you're looking at,
your your plan at SCAN and how things
are moving forward, you know, what are you
thinking about the future? How are you seeing
some of these plans and options evolving to
meet the needs of,
you know, patients as well as providers?
I think that it's it's really given that
the STARS compression
and some of the challenges we just talked
about,
there are
some plans that are really
having to reimagine,
how they're serving the members. And I think
a big part of that is technology. We're
going to see
very material changes in the way that technology
gets applied. And I'm actually very excited about
that. You know, we've been talking last ten,
fifteen years about AI, and we're we're finally
now, I think, at a point where we're
through the hype cycle.
It's real. It's here. You know? And what's
special now is in this moment, we have
this confluence of
technology that's caught up to the hype
coupled with
a generation of folks whom are 65 to
75, whom were really, in many ways, the
first generation of smartphone users. Right? These are
folks that are digitally savvy. They're digitally engaged.
And we're at a point in the industry
where we are under severe pressure
from a from a revenue point of view,
and we need to find ways to be
more efficient. And when you put those three
forces together,
the the market now is really ready, I
think, to see
very rapid adoption and innovation when it comes
to
technology and its application to solve the problems
that have been plaguing us for so long.
So I'm that's where I think we're gonna
see a lot of activity over the next
twelve months. The other is gonna be, of
course, you know, benefit structures.
I anticipate we're gonna continue to see degradation
in in benefit structures for many carriers that
are facing
starts cuts that are facing,
the revenue pressures that were that I just
talked about,
and those that have star superiority that are
gonna lean into and really take advantage of
an opportunity
to go to market with a with a
stronger set of benefits, which will really make
for a very interesting
AEP this coming fall.
Got it. That's really helpful to know and
definitely,
appreciate,
the insight there and especially looking into what's
coming up in the next few months. Now,
obviously, a lot of exciting things you talked
about. Is there anything else that you're really
excited about, and and what makes you nervous?
You know, I'd say, you know, the technology,
of course, I'm excited about. I'm excited that
we have a a regulatory environment that's now
appears to be very supportive for MA, which
is great. You know, this is a product,
Laura, that we have a lot of deep
conviction in. This is it is, you know,
we really believe MA is better experience, better
value, drives better outcomes, and there are a
lot of empirical data and facts that support
that.
So
while there have been perhaps some players whose
interests are not aligned to the right outcomes
for a plan like us us that's nonprofit,
with a favorable regulatory environment, we can really
bring this product in the way that it
was intended
to the market, to more consumers, and that's
something that we're excited about. What keeps
me up at night,
I'd say, Laura, to the the latter part
of your question, is this idea that there's
there are irrational actors in the market. There
always will be.
And and they're just out there chasing unsustainable
growth. And the way that manifests,
Laura,
is, you know, you have players coming in
with economically
just unsustainable benefits structures,
that are looking for these, you know, magical
s curves. And when those plans can't afford
to fund those benefits year on year,
they begin to cut benefits or worse, they
exit altogether.
And that is what leads to this massive
instability and disruption for members, and that's just
really terrible. And I think
we really,
as leaders, need to remember that there's a
person at that every at the center of
every product that we're putting out to market,
and we have a responsibility to build products
that are durable to serve them over time.
And that's the one thing that that does,
give me some anxiety.
It makes a lot of sense. You know?
And and, certainly,
it's such a challenge out there with the
different health plans coming up and,
certainly
appreciate your analysis
of how things are are headed. You know?
And when those exes do occur, when some
of those benefits changes, how does that impact,
you know, other health plans, patients, and communities,
you know, in ways that, they might not
have
planned for? Or, you know, what, I guess,
responsibility or accountability comes up to them, as
these
other organizations?
I think, you know, the best way to
to to look at this is just from
the eyes of of a member. I mean,
just imagine,
you know, you're
67,
60 eight. You've just been diagnosed with cancer.
You begin
a course of treatment.
You know, you're already polychronic. You're already seeing
a number of specialists, and now you throw
in an oncologist
and some additional specialists into the mix.
You're at a point where you're scared, you're
nervous,
and then suddenly you get a notice from
your provider or from your your carrier that,
hey. We're we're leaving. We're leaving. And now
you need to
in this moment of such extreme
need
and worry,
go find a new plan, a new provider.
You gotta figure out a whole new network
of doctors.
You have to somehow think about,
you know, maintaining continuity care for yourself, and
there's no one there to help you do
it. There's no one there to help you
do it.
And that's what this looks like
to a customer.
And I think we all need to remember
that.
And, you know, we all have different roles
to play. From a carrier point of view,
I think it starts with deliver building products
that are sustainable
that then do not result in the type
of exits that we've seen. And from a
provider point of view, I think it is
working with consumers who are in those situations
to really try to make those transitions as
seamless,
as they can be. And I know that
there are things that carriers are doing, working
with providers to make these type of disruptions
less
challenging.
But what I challenge the industry is can
we behave in a way that doesn't get
us in these situations to begin with?
Yeah. It's such a a great message and,
you know, really, really, powerful,
storytelling you had there. So thank you so
much, Santu. I appreciate it. Before we wrap
up here, I'm going to look into the
future. What will the most effective health care
leaders need in order to be successful in
the next two to three years or so?
Okay. I I love that question. It's something
that we spend a lot of time,
thinking about at SCAN,
amongst our leadership team. I'll I'll share I'll
share my personal thoughts,
Laura. I think, first of all,
embracing AI.
There's
what I think, is way too much intellectual
outsourcing going on when it comes to this.
And what do I mean by that? We
as leaders really need to commit, really commit
to educating ourselves on what AI can do,
and then take
what I'd call ownership of actually connecting the
dots to real world use cases. We have
to do it.
And the leaders who understand both the business
and the technology side of things when it
comes to AI, they are the ones that
I think are gonna drive the most impact.
I think second,
a focus on simplicity.
I just think leaders who are laser focused
on
getting the blocking and tackling right every single
time are going to pull ahead. There's a
lot of narrative out there amongst health care
leaders on how sophisticated the sector is becoming,
how great our system is. You know, there's
there's just a lot of flowery language on
things like hyper personalization
segments of one. And I just think we
need to cut the the BS to be
frank about it because it's it's just totally
disconnected from reality.
The reality is this is an industry, and
I include ourselves in this, where we can't
get the simple things right every time, and
that is what matters to our consumers.
You know, there's
there's companies out there outside of health care
that are really solving extremely hard problems,
you know, quantum computing, commercial space flight,
automated drivings. And,
you know, I think about our sector,
we can't figure out how to communicate with
a % accuracy,
a provider directory, you know, the address and
phone numbers of the doctors who are networked
to us. We can't, you know, figure out
how to streamline billing between a member and
a provider and a carrier so that's right
every time. And so, you know, when you
think about that, it's just kinda shocking. And
instead of really digging in to solve these
basic issues, we're out there pursuing things that
don't really make a difference in a real
way. I think that that's something that's gonna
be important. And the last thing is I
just think we need to be more empathetic.
We need to be real really, I think,
way deeper in the shoes of our customers
and wrap our arms around that. You know,
health insurance is is the ultimate consumer
service or product. You are essentially
signing your well-being away to this faceless, nameless
company, and the only essence you have of
who they are is the person who picks
up on member services when you call in.
And that's extremely scary.
And I think if we as a as
an industry understood that really put ourselves in
the shoes of our consumers and understood that
what they're going through, health insurance would look
a lot different than I did today. It
would work a lot differently.
And that's what we're trying to do here
at SCAMP. You know, we're really trying to
drive empathy
into every decision that we make because, ultimately,
the our members are at the center of
everything that we do.
That's amazing to hear. You know? And certainly
such a strong and powerful message for the
entire industry and then,
a great vision for where you're going with
Scan Health Plan. Santhu, thank you so much
for joining us on the podcast today. This
has been a really fantastic conversation, and I
look forward to connecting with you again soon.
Laura, it's my pleasure. Thank you for taking
the time.