Hello, everyone. This is Jacob Emerson with the
Becker's Payer Issues podcast.
Thrilled today to be joined by doctor Joe
Camara, who is the chief medical officer at
SCAN. Doctor Camara, thank you so much for
taking the time to be with me on
the podcast today.
Absolutely. It's a pleasure to be here, Jacob.
Thank you so much. Yeah. Absolutely. And before
we dive into everything we wanna talk with
you about, Joe, can you tell us a
little bit more about yourself, your background in
health care, and what it is that you
do today at SCAN?
Sure. Absolutely. My pleasure.
So I serve as our chief medical officer
here at SCAN Health Plan. And in that
function, I oversee the development and implementation
of SCAN's clinical strategy across not just the
health plan, but also its affiliated medical groups.
And,
the my purview is over the clinical quality,
utilization management,
the population health care case management, pharmacy, and
the clinical innovation functions. And so
for me,
I'm a primary care physician through and through.
I trained in primary care internal medicine, did
my fellowship training in health services research, and
have focused
my career really on the design and improvement
of care, particularly in the outpatient ambulatory care
system space.
For the past two decades, I worked both
as a clinician and an executive,
really in value based provider organizations.
Most of my time was spent in Eastern
Massachusetts at Atrius Health and Harvard Vanguard,
which was the provider side of the old
Harvard Community Health Plan. And I served as
chief medical officer there from '16 to '22.
And prior to joining SCAN, I actually spent
three years, within a specialty BBC
startup,
serving as chief medical officer for Somatas,
which was a value based specialty care provider
in McLean,
really trying to help patients with chronic kidney
and cardiovascular
disease to avoid those downstream complications. So, kind
of been through the circuit, mostly on the
provider side, and, we're really excited to be
in this space here with a health plan,
thinking about progressive ways to really help our
members and patients stay healthy.
Fantastic. Well, we're really glad to have you
here with us to get your take on
Medicare Advantage specifically and and where you think
that program is is going to evolve and
keep going.
So let's talk a little bit about that.
Obviously, it's a MA, it's a very dynamic
program. It's it's constantly changing. There's lots of
headlines all the time,
about the state of the market. And we
continue to see SCAN,
scale,
there are lots of expansion into new markets.
So from your perspective, Joe, what are some
of the factors that you see driving
future growth in the MA space?
And how is SCAN position positioning itself,
to address challenges and opportunities in in what
we know, like I said, is a very
evolving and dynamic
market?
That's a great question, Jacob. Thanks.
So
I I think in the Medicare Advantage space
in particular,
there is
the fact that health care for our seniors
and older Americans
really,
does get more complex,
gets more complicated, and our delivery system continues
to be
fragmented. Although, I know coming from the provider
side, there's lots of efforts to try to
streamline and make things more efficient and coordinated.
But the the reality is that we're still
in a space where it becomes more and
more challenging, the more complex your health becomes.
And
where I think MA truly does deliver better
value than the sort of the traditional fee
for service Medicare chassis.
Traditional Medicare often
exposes seniors, I would say, to sort of
higher out of pocket costs and some of
the things that we know are equally as
important
to sort of the traditional clinical care like
vision, hearing, and dental,
are all sort of elements of day to
day health care for seniors that,
are sort of if wrapped together and coordinated,
actually provide
better outcomes for everyone.
MA does allow that kind of innovation, right,
by offering that coordinated integrated care,
and pushing
all of us to be focusing on not
just what we're doing, but what are the
outcomes of what we're doing? How did those
outcomes get better?
And here at SCAN, I'd say that we're
really trying to leverage that flexibility,
to try to get the right benefits, the
right clinical care, the right coordination
put in place, to be sure that we're
meeting seniors where there are, as well as
trying to simplify the overall health care experience
for our members, as well as for our
provider partners.
And you you alluded to the fact that
sort of there are some challenges right in
the landscape ahead. And
as we look around,
there are a lot of
folks that are hesitating around Medicare Advantage and
sometimes
backing off a little bit. But for us
as a non for profit
health care plan, we do believe that,
we have an opportunity,
right, to really
showcase what we can do, when we have
this kind of coordinated care and coverage benefit
ability, that we can invest
more in that better care, invest in more
stable and comprehensive benefits,
and invest in being sure that we are
there to provide that long term value for
our members.
And we could do it because of the
ability that as a non for profit,
we're thinking about the long game. We're not
there necessarily for short term profits.
And it has allowed us at SCAN to
to really do a lot of innovative things.
For example, you know, we've we've been out
sort of at the forefront
of launching,
first of their kind plans around personalized care
for,
women, inspired our inspired plan for women or
our firm plan for the LGBTQ
plus seniors and the allied plan for our
Asian senior population. So,
again, right, that that creativity and the flexibility
that MA provides,
coupled with our commitment and our mission as
a nonprofit,
really allows us to be bullish about the
fact that we can continue to serve more
and more members across this country,
to be able to provide that kind of
care where it's needed, whether it's in the
home, in the community, or even virtually. So
super excited about the opportunity and really pushing
forward to try to make sure that,
we can continue to drive improvements and health
outcomes for seniors.
Absolutely. And to your initial point, Joe, I
mean, we've seen study after study,
and certainly on the ground experience like yours
show that MA, it offers lower out of
pocket costs, better benefits,
better outcomes across many different,
spaces
for seniors. So your point is well heard.
But I wanna follow-up on on something you
mentioned in terms of SCAN really does stand
out among the in the MA industry in
terms of very specific and personalized
plans for for certain populations,
Asian Americans, LGBTQ,
older
adults. So, you know, so much of your
career has been based in in innovation and
value based,
care. So as you lead scans efforts in
this space,
how do you envision the role of technology,
data analytics in in shaping that more personalized
and effective care delivery for your,
now more than 300,000
members?
Yeah.
It's a great question, Jacob.
And and, sort of the the side that
perhaps I missed in my intro bio is
that I'm actually,
boarded in internal medicine, but also boarded in
clinical informatics. So technology and data analytics
are a core part,
of why I think healthcare is heading forward.
And in this twenty first century, realizing we're
twenty years into it now, but,
we're really in a spot where there's some
exciting new capabilities,
addressing some of the challenges. Right? Of How
do we actually make sure that not only
the reliability
of getting evidence based care,
is happening more consistently across our population,
but to your point around how do you
then personalize that care, so it doesn't feel
like we're doing cookbook or recipe based medicine
on everybody. Because every every member, every
person has unique challenges, a unique set of
circumstances that they're dealing with. Even if there's
they're sort of all working and trying to
optimize the care for common disease or common
conditions. So I think technology and analytics are
really critical enablers of this kind of personalized
coordinated experience. And we're a strong believer at
SCAN that the technological abilities that we bring
forth are gonna be foundational
for being able to provide that kind of
care,
going forward. And,
again, there's a lot of hype, Jacob. And,
you know, and I think I've having heard
prior podcast as well too, I think everyone
recognizes,
you know, artificial intelligence, all the advanced analytics
capabilities.
There's a lot of flash that is happening
within our industry.
And it's really, really important to make sure
that, you know, we're not chasing sort of
that Gartner
sort of early part of the hype cycle,
but we're really trying to target using the
right technology
at the right time to match the care
and support with the members and patients that
really need it. And there's an eye towards
trying to use that technology
to simplify,
to,
expediate the care, and try to make sort
of care more effective for our members, but
also our provider partners, for our workforce.
And everyone sort of involved wrapping around the
care for those patients.
And technology does enable that. Right? So our
our capability of using data, using the ability
to sort of say, you know, you have
one cohort of patients, say they have congestive
heart failure, dementia, or even diabetes,
but within that
seemingly
homogeneous group, you have a lot of different
sort of
that data analytics can help surface and make
it more efficient and more
effective in terms of how care teams,
including those on our side at SCAN, but
also collaborating with our network provider partners, can
really wrap around the services
where and when it's needed, whether it's in
the home, on the street, in the clinic,
or even virtually. And,
that kind of capability
was hard to do. Right? Definitely hard to
do twenty five years ago when we're all
on paper charts,
but it makes it a lot easier today,
when you've got these kinds of ability to
interchange and exchange that data,
and information
across the network of providers.
And, you know, I would say that the
virtual capability that we're seeing post COVID,
continues to make sort of, if I could
say, sort of open up opportunities
to try to really improve access and care,
for patients and members who are in sort
of isolated areas,
that perhaps aren't being served as well by,
the providers in the community, or honestly, the
providers are overwhelmed. Right? We're seeing that a
fair amount,
in terms of access issues,
across the board. And when we think about
that virtual type care though, we do need
to keep in mind that we need to
make sure that that system works with our
older adults in mind.
So we at SCAN have also invested in
parallel, right, to really push digital literacy, digital
support to make sure the tools are as
accessible and easy to use.
And the last part of your question, Jacob,
I think was around data analytics. And this
is sort of an area that's dear to
my heart around population health.
And
the idea of
enabling proactive world class care is something that
I've always been super, super passionate about. And
as a primary care clinician, it feels like
that's our raison d'etre, right, to really be
at that place where I can help our
patients and members
prevent that hospitalization,
prevent that rapid disease progression,
prevent,
sort of the aspects of,
mental health challenges from isolation.
Because if I can detect it sooner and
know who is at risk, it gives me
a chance to intervene
probably with a sort of more efficient type
intervention, but also a more humane intervention. Because
when those complications happen, we all know, we
see it all the time,
it is wonderful to provide world class care.
But at that time, you're kind of really
behind the eight ball, and you're chasing to
try to rectify situation instead of truly preventing
it. And I think there's no one in
the world that would argue that if we
could just,
you know, hold true to our adage of
an ounce of prevention is worth more than
a pound of a cure,
it really does make this place,
a lot better for all of us in
terms of reducing suffering. And I think data
analytics become and form the foundation
of enabling us to be able to do
that much more efficiently and effectively.
Certainly. Certainly. And, you know, speaking of proactive
care, let me let me spout off a
stat to you that I know you're familiar
with,
and certainly, I would imagine most of our
audience is familiar with it. Around 10,000 Americans
a day are aging into Medicare.
We expect that that number to keep growing,
in terms of the overall ratio there. So
how do you how how does SCAN how
how are you thinking about that? How are
you preparing for that, navigating,
what's already here?
And from your perspective, given what we were
just talking about, Joe, in terms of population
health and data analytics, how do you continue
to to view where the health care landscape
is gonna change over the next three to
five years when it comes to meeting this
demand for senior care?
Yeah. It's a great question, Jacob, and something
that definitely we think a lot about.
And,
you know, the the the demand side there
with the 10,000
patients sort of entering into Medicare,
is coupled with the similar stat that I
I know that you're also familiar with where,
you know, we have a lot of our
workforce
stepping away, early retirements, folks sort of stepping
away from direct care provider capabilities. And so,
we're facing a little bit of a storm,
right, going forward to say increasing need, decreasing
capacity to care for, the
the need.
But also, I'd add that third bit, which
says, medical science is advancing. So guess what?
We have more effective treatments available today to
really change the,
trajectory of some of these clinical conditions that,
again, in the past used to be much
more much more difficult to manage effectively. And
I think chronic kidney disease is one great
example of that with, the new medications that
are now available.
And I do think that this is where
we do need to partner,
very strongly with our provider partners,
and try to figure out how do we
bring the strength of a health plan, with
the strength of the provider groups to really
try to to thread this needle of making
sure that the members
that really have the needs that,
are paramount,
overall, not just from an experience perspective, but
clearly from a health outcomes perspective,
get the types of care that they need
despite the fact that access is challenging,
everywhere that we look. And so, you know,
we've
announced a couple of sort of partnerships with
large groups like Estrana and Sutter Health here
in California, where we're really trying to figure
out how do we work together,
to try to address those kinds of demand
and capacity
challenges.
But on top of that though, I mean,
as a primary care clinician, I would say
there's another aspect here that's really important for
us, and that or it's really pushing,
our ability to be able to help and
coach our members,
to be able to be as effective as
possible as they're navigating
through. And, you know, we think about our
care coaching programs,
for our SCAN inspired members,
offers a lot of personalized one on one
coaching to tackle
many of the primary concerns of our members.
And again, these kinds of programs, when you
have activated
engaged and educated members,
it it enables sort of that member to
become an active role of the care team,
and therefore, also,
become more effective agents of their health care.
And, again, I think as we're looking at
health plan and providers as two different arms,
I do think our members provide yet a
third arm, right, of us being able to
work together,
to try to,
address some of the challenges that we're facing.
And it is really, really,
a challenge that, again, technology, you know, referencing
our prior conversation,
also begins to help us with. Because
in the past, I would say that information
was
more sequestered, I would say, in the care
delivery space overall.
But with the information, with the kind of
tools that are available to the general public,
you know, health care information is democratizing. And
that is enabling our members and our patients
to be much more informed around what they
should be getting, when they should be getting
it, how they should be getting it, and
how they prefer. And,
we wanna empower our patients and our members
to really be that kind of strong agent
and advocate for their care. And I think
all of it becomes important to address the
challenges that you mentioned.
Absolutely. Well, exciting things ahead,
in the in the senior care space, and
it'll be fascinating to watch scan continue to
innovate there.
Before we go, Joe, what else are we
missing? You got a lot of health plan
leaders and and MA leadership listening in from
from all over the country. What do you
wanna share with them? Any any final bits
of advice, you'd offer?
Yeah. No. Thank you for that opportunity. And
thank you again, right, for this chance to
actually speak with you and, to to share
my 2¢ here.
I get that at two comments.
One is that, again, acknowledging where we're at
today
with the complexity
and
the fragmentation
that just exists in health care,
really to
try to be as straightforward as possible in
terms of keeping that member experience at the
center of everything.
We try to push greater
performance in terms of clinical outcomes or other
kinds of KPIs and metrics,
and that can sometimes drive,
more complexity.
And,
we like to say that complexity isn't the
sign of sophistication.
It's more signal that perhaps we lost sight
of what we're trying to do and who
we're trying to serve. So first point would
be, again, to really, really keep laser focused
on that member experience.
And
the second point, probably as a corollary to
that, Jacob, is that,
we do believe that's the next revolution
in terms of digitalization
of health care,
really comes with the interoperability
coming into its own. And I think as
we're seeing,
the new sort of capabilities
really start to open up a more freer
flow of data and information across health plans,
providers, and patients,
there is a tremendous
opportunity here to reduce that friction, eliminate the
waste, and make room for real collaboration. So,
the second piece would be to keep an
eye on that interoperability
coming and
be ready to be able to jump in,
and be more effective partners in connecting,
our care across all the different domains. Because
I think it's gonna be an exciting,
window coming forth.
Wonderful. Well, doctor Kimura, thank you so much
for taking the time to sit down with
us and for sharing your insights with our
audience. We we really appreciate it.
Absolutely, Jacob. It was a privilege, and thank
you so much. Yep.
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