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This is Laura Dirda with the Becker's Healthcare

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podcast. I'm thrilled today to be joined by

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Sentu Aramugam,

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who's a chief commercial officer at ScanHealth Plan.

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Sentu, it's a pleasure to have you on

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the podcast today. Thank you. Really happy to

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be here. Now I'm excited for our conversation

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because I know you've got so many great

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things happening there at Scan Health Plan and

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truly are at the forefront of many invasions

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in health care and really,

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making sure that populations are covered in in

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a great way. But before we dive into

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that, I was wondering, can you tell us

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a little bit more about yourself and your

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background?

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Yeah. I'd be happy to.

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So as you said, I'm the chief commercial

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officer here at Scan,

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and I'm accountable in that regard for our

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sales,

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our product, and our marketing organizations,

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across the enterprise.

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Prior to SCAN,

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I was a partner at McKinsey and Company

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in their health care practice. I worked with

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Medicare Advantage Plans and academic medical centers across

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the country on

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growth strategy,

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operations, turnarounds,

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and transformations.

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It's amazing to hear. You know? And and

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what a a great way to,

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unfold your career, especially in ways that are

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impacting,

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people across the country. Now from your perspective,

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what are some of the biggest issues that

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you're following in health care right now?

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That's a that's a big question. There's a

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lot unfolding right now,

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as you know, Laura, and a lot of

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uncertainty in the in the market.

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With that said, I'll I'll hit a few

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things on my mind. First, of course, the

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final notice,

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especially being the middle of mid season,

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we're tracking this very closely, as you can

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imagine.

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We're hoping that there's some relief, particularly in

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the revenue compression that was foreshadowed,

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in the mass notice, especially in the part

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d side. So that's that's definitely top of

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mind.

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Second, I'd say we're really tracking very closely

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this idea of disruption driven shopping, and this

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is a really big one.

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With the revenue compression that we have seen

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in the industry combined with the stars downgrades

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that a lot of carriers have been exposed

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to over the last twelve months,

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it's causing a lot of MA plans to

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really scale back. And not just MA plans,

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provider systems as well, just exiting MA,

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and that's causing really severe access issues for

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MA members. You know, this year, I think

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the stat that I'd seen

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was something to the effect that there's going

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to be almost 2,000,000

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folks who will be having choose a new

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MA plan because of a disruption event.

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And that's really just unprecedented in scale. And

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so, you know, at SCAN, plan stability, benefit

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stability, something so

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fundamentally important to us.

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We see ourselves

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in a real prime position to serve the

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members that are gonna be impacted by these

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these disruptions.

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Absolutely. That makes a lot of sense. You

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know, it's been fascinating to see that evolution

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of those MA plans. And then as you

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mentioned, you know, a lot of the disruption,

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especially over the last twelve months or so.

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You know, and so when you're looking at,

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your your plan at SCAN and how things

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are moving forward, you know, what are you

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thinking about the future? How are you seeing

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some of these plans and options evolving to

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meet the needs of,

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you know, patients as well as providers?

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I think that it's it's really given that

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the STARS compression

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and some of the challenges we just talked

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about,

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there are

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some plans that are really

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having to reimagine,

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how they're serving the members. And I think

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a big part of that is technology. We're

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going to see

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very material changes in the way that technology

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gets applied. And I'm actually very excited about

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that. You know, we've been talking last ten,

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fifteen years about AI, and we're we're finally

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now, I think, at a point where we're

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through the hype cycle.

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It's real. It's here. You know? And what's

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special now is in this moment, we have

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this confluence of

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technology that's caught up to the hype

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coupled with

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a generation of folks whom are 65 to

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75, whom were really, in many ways, the

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first generation of smartphone users. Right? These are

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folks that are digitally savvy. They're digitally engaged.

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And we're at a point in the industry

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where we are under severe pressure

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from a from a revenue point of view,

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and we need to find ways to be

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more efficient. And when you put those three

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forces together,

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the the market now is really ready, I

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think, to see

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very rapid adoption and innovation when it comes

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to

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technology and its application to solve the problems

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that have been plaguing us for so long.

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So I'm that's where I think we're gonna

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see a lot of activity over the next

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twelve months. The other is gonna be, of

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course, you know, benefit structures.

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I anticipate we're gonna continue to see degradation

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in in benefit structures for many carriers that

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are facing

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starts cuts that are facing,

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the revenue pressures that were that I just

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talked about,

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and those that have star superiority that are

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gonna lean into and really take advantage of

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an opportunity

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to go to market with a with a

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stronger set of benefits, which will really make

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for a very interesting

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AEP this coming fall.

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Got it. That's really helpful to know and

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definitely,

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appreciate,

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the insight there and especially looking into what's

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coming up in the next few months. Now,

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obviously, a lot of exciting things you talked

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about. Is there anything else that you're really

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excited about, and and what makes you nervous?

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You know, I'd say, you know, the technology,

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of course, I'm excited about. I'm excited that

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we have a a regulatory environment that's now

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appears to be very supportive for MA, which

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is great. You know, this is a product,

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Laura, that we have a lot of deep

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conviction in. This is it is, you know,

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we really believe MA is better experience, better

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value, drives better outcomes, and there are a

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lot of empirical data and facts that support

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that.

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So

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while there have been perhaps some players whose

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interests are not aligned to the right outcomes

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for a plan like us us that's nonprofit,

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with a favorable regulatory environment, we can really

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bring this product in the way that it

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was intended

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to the market, to more consumers, and that's

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something that we're excited about. What keeps

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me up at night,

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I'd say, Laura, to the the latter part

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of your question, is this idea that there's

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there are irrational actors in the market. There

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always will be.

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And and they're just out there chasing unsustainable

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growth. And the way that manifests,

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Laura,

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is, you know, you have players coming in

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with economically

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just unsustainable benefits structures,

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that are looking for these, you know, magical

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s curves. And when those plans can't afford

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to fund those benefits year on year,

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they begin to cut benefits or worse, they

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exit altogether.

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And that is what leads to this massive

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instability and disruption for members, and that's just

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really terrible. And I think

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we really,

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as leaders, need to remember that there's a

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person at that every at the center of

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every product that we're putting out to market,

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and we have a responsibility to build products

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that are durable to serve them over time.

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And that's the one thing that that does,

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give me some anxiety.

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It makes a lot of sense. You know?

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And and, certainly,

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it's such a challenge out there with the

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different health plans coming up and,

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certainly

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appreciate your analysis

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of how things are are headed. You know?

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And when those exes do occur, when some

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of those benefits changes, how does that impact,

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you know, other health plans, patients, and communities,

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you know, in ways that, they might not

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have

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planned for? Or, you know, what, I guess,

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responsibility or accountability comes up to them, as

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these

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other organizations?

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I think, you know, the best way to

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to to look at this is just from

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the eyes of of a member. I mean,

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just imagine,

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you know, you're

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67,

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60 eight. You've just been diagnosed with cancer.

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You begin

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a course of treatment.

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You know, you're already polychronic. You're already seeing

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a number of specialists, and now you throw

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in an oncologist

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and some additional specialists into the mix.

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You're at a point where you're scared, you're

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nervous,

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and then suddenly you get a notice from

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your provider or from your your carrier that,

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hey. We're we're leaving. We're leaving. And now

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you need to

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in this moment of such extreme

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need

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and worry,

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go find a new plan, a new provider.

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You gotta figure out a whole new network

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of doctors.

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You have to somehow think about,

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you know, maintaining continuity care for yourself, and

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there's no one there to help you do

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it. There's no one there to help you

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do it.

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And that's what this looks like

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to a customer.

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And I think we all need to remember

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that.

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And, you know, we all have different roles

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to play. From a carrier point of view,

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I think it starts with deliver building products

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that are sustainable

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that then do not result in the type

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of exits that we've seen. And from a

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provider point of view, I think it is

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working with consumers who are in those situations

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to really try to make those transitions as

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seamless,

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as they can be. And I know that

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there are things that carriers are doing, working

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with providers to make these type of disruptions

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less

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challenging.

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But what I challenge the industry is can

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we behave in a way that doesn't get

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us in these situations to begin with?

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Yeah. It's such a a great message and,

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you know, really, really, powerful,

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storytelling you had there. So thank you so

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much, Santu. I appreciate it. Before we wrap

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up here, I'm going to look into the

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future. What will the most effective health care

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leaders need in order to be successful in

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the next two to three years or so?

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Okay. I I love that question. It's something

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that we spend a lot of time,

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thinking about at SCAN,

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amongst our leadership team. I'll I'll share I'll

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share my personal thoughts,

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Laura. I think, first of all,

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embracing AI.

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There's

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what I think, is way too much intellectual

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outsourcing going on when it comes to this.

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And what do I mean by that? We

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as leaders really need to commit, really commit

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to educating ourselves on what AI can do,

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and then take

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what I'd call ownership of actually connecting the

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dots to real world use cases. We have

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to do it.

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And the leaders who understand both the business

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and the technology side of things when it

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comes to AI, they are the ones that

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I think are gonna drive the most impact.

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I think second,

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a focus on simplicity.

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I just think leaders who are laser focused

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on

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getting the blocking and tackling right every single

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time are going to pull ahead. There's a

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lot of narrative out there amongst health care

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leaders on how sophisticated the sector is becoming,

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how great our system is. You know, there's

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there's just a lot of flowery language on

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things like hyper personalization

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segments of one. And I just think we

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need to cut the the BS to be

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frank about it because it's it's just totally

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disconnected from reality.

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The reality is this is an industry, and

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I include ourselves in this, where we can't

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get the simple things right every time, and

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that is what matters to our consumers.

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You know, there's

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there's companies out there outside of health care

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that are really solving extremely hard problems,

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you know, quantum computing, commercial space flight,

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automated drivings. And,

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you know, I think about our sector,

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we can't figure out how to communicate with

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a % accuracy,

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a provider directory, you know, the address and

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phone numbers of the doctors who are networked

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to us. We can't, you know, figure out

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how to streamline billing between a member and

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a provider and a carrier so that's right

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every time. And so, you know, when you

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think about that, it's just kinda shocking. And

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instead of really digging in to solve these

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basic issues, we're out there pursuing things that

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don't really make a difference in a real

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way. I think that that's something that's gonna

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be important. And the last thing is I

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just think we need to be more empathetic.

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We need to be real really, I think,

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way deeper in the shoes of our customers

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and wrap our arms around that. You know,

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health insurance is is the ultimate consumer

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service or product. You are essentially

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signing your well-being away to this faceless, nameless

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company, and the only essence you have of

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who they are is the person who picks

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up on member services when you call in.

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And that's extremely scary.

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And I think if we as a as

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an industry understood that really put ourselves in

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the shoes of our consumers and understood that

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what they're going through, health insurance would look

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a lot different than I did today. It

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would work a lot differently.

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And that's what we're trying to do here

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at SCAMP. You know, we're really trying to

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drive empathy

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into every decision that we make because, ultimately,

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the our members are at the center of

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everything that we do.

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That's amazing to hear. You know? And certainly

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such a strong and powerful message for the

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entire industry and then,

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a great vision for where you're going with

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Scan Health Plan. Santhu, thank you so much

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for joining us on the podcast today. This

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has been a really fantastic conversation, and I

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look forward to connecting with you again soon.

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Laura, it's my pleasure. Thank you for taking

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the time.