Hello, everyone. This is Jacob Emerson with the
Becker's Pay Your Issues podcast.
Thrilled today to be joined by Zach Myers,
who is the national general manager at ScanHealth
Plan. Zach, thanks so much for taking the
time to be with me on the podcast
today.
Yeah. Thank you.
So before we dive into everything we wanna
talk with you about, Zach, and all the
latest going on at SCAN, can you tell
us a little bit more about yourself, your
background in health care, and what it is
that you do at the company?
Yeah. Sure. Well, as you shared, I'm SCAN's
national general manager. I'm responsible for the performance
and operations
of our markets across the country, and and
we're a growing health plan. We're now in
five states, soon to be six,
across the country with over 300,000 lives that
we are responsible for the care of. You
know, I started my career in health care
technology. I kind of grew up in it,
Jacob. I my family owned a company back
in the day called CECity,
terribly named business. We could have used scans
marketing team, but,
we built
interesting technology in the early days of healthcare
tech that helped primary care physicians measure the
way
they delivered care and the quality of care
they were delivering and then helped them to
get paid under the earliest pay for performance
programs that CMS,
put out.
I helped lead the sale of that business
to premiere in 2014
and then spent really the next decade of
my career in the world of Southern California.
Senior care.
Really devoted to the mission of how to
improve the quality of life for seniors. First
first at a company
called CareMore Health, where I ran their largest
P and L for a number of years.
And then here at SCAN. So excited to
to chat with you about all things
payers, providers and and how to improve care
for seniors.
Yeah. Absolutely. So you've been in the industry
for a long time, Zach. It sounds like
it's personal for you as well. You've seen
a lot of different trends and and different,
directions the industry has gone over over the
last decade or so. So you you mentioned
Skin is going to be expanding into its
sixth states. The the company continues to expand
into new markets.
Talk to us about some of the factors
that you see driving future growth for Medicare
Advantage right now. There's obviously so many headlines,
so many changes we've been hearing about over
the last few years within the program.
So where do you see SCAN positioning itself
to address some of the challenges and the
opportunities in what what is, you know, is
a very evolving market?
Yeah. Yeah. Well,
you know, despite all of the various headlines
we've seen in the industry, I think the
reality is that seniors have really
voted for the MA program with their feet.
Now we now have more than half of
all seniors in the Medicare Advantage program in
large part because they've seen the real value
proposition right around having access to
additional benefits, comprehensive
coverage
in particular
for those seniors living on fixed incomes,
who really depend on stable, affordable access to
care that's not possible
under
a Medigap policy or Medicare fee for service
alone.
You know,
I think even in the face of that
growth, what we've seen is some real headwinds
in the industry,
margin compression,
changes to the payment model in part because
of v twenty eight,
and a general decline in national stars ratings,
across many plans.
You know, most health plans have reacted to
that
by pulling out of the markets. I think
we're going to see hundreds of thousands of
seniors
lose access to their health plan, this AEP,
or really squeezing their provider partners.
You know, we've seen real growth in claim
denials,
increasing
use of burdensome prior authorization.
And the result is really a vicious cycle.
Right? You see
a provider's less happy. You see plans pulling
back on benefits. The result is those plans
have worsening member experience, worsening star scores, and
ultimately,
you know,
the the circle kind of continues. And I
think where SCAN
as a nonprofit
health plan who's been in this industry for
decades,
we're positioned to take a different approach.
We have the opportunity to reinvest our margin
back into our members and our provider partners.
And our vision is really to be the
most preferred partner for providers,
and health systems across the country.
And what that allows us to do is
create a virtuous cycle instead of
the sort of downward spiral I was just
describing. So so you see fair payment for
providers
not playing games with claim denials and prior
auth, you know, creates better alignment with your
groups.
The result is a better member of experience
and improved STARS performance.
You know, at SCAN, we've seen that we've
had,
four plus star performance for for over a
decade in in our core market in California
and, ultimately,
higher revenue that we can re invert reinvest
in member experience and growth. And
so we see a different way of approaching
the market that will allow us to win
in in the face of of all the
change in the industry.
Does does that make sense, Jake? It it
does make sense, and it's it really aligns
with everything that we consistently hear both from
the hospital leaders and from the health plan
leadership pretty much every day at this point,
Zach, in terms of the squeezing of profit
margins of of providers,
the turmoil that everyone is expecting membership wise
heading into AEP.
But I know, you know, speaking from with
SCAN leadership over the years, it's it's really
great to consistently hear how the company acknowledges
these industry problems and then tackles them head
on,
and and wants to to fix them. I'll
just mention, you know, we the proof point
for that from a scam perspective is we're
now not really pulling out of any markets.
We're expanding into the markets as AEP. And
so you're gonna see us sort of with
with hopefully market leading benefits,
expanding into our sixth state, continue to grow
in the states that we operate in. And,
so we're excited about that. Yeah. No. It's
really great to hear, and it definitely is
in contrast to, obviously, a lot of other
big players out out there. I wonder you
know, I know there's a lot going into
just this enrollment period, but if you were
looking at the health care landscape in terms
of how it's been evolving and how it
will evolve over the next three to five
years or so,
is there anything in particular that stands out
when it comes to Medicare Advantage? Any predictions,
that you would wanna share? It's
hard to predict where this I know. This
you know, is it there's so many you
know, it's at the whims of CMS in
many ways. But, you know, I think we're
we're gonna see
Medicare Advantage
continue to play an important role for seniors
and for the government.
I think it will evolve in pretty significant
ways. I think plans are gonna have to
adapt to tighter margins,
which is gonna require
being very thoughtful about how do you deliver
meaningful value to seniors through the right benefits,
not gimmicks,
and then build the kind of provider partnerships
that can actually bend the cost curve and
keep patients independent and and healthy, which is,
you know, fundamentally
our mission.
And I think part of that's gonna be
the reality of changing technology. Of course, AI,
But also, you know, we're seeing real novel
medications, therapies, testing modalities.
And at scan, we're thinking very creatively about
how do you build sort of the care
models of the future that can wrap around
and support our provider partners
to improve quality of life and create savings.
But I think that's gonna be a really,
like, narrow,
line to to tiptoe here over the next
few years. As a nonprofit, I think SCAN's
pretty well positioned to
to lead
in in across all of those different changes
that I that I just talked about. And,
you know, we really wanna demonstrate how mission
driven organizations
can
help set the standard
for what Medicare
becomes and looks like.
Yeah. No. Absolutely. I mean and I appreciate
your candidness around that topic as well there,
Zach. And I I wonder if we're if
we're sticking on the topic of caring for
the most vulnerable, and certainly that applies to
a big swath of the Medicare
population.
One area we've really seen a lot of
growth, more than traditional Medicare Advantage, in terms
of growth over the last few years is
within special needs plans.
And so can you talk to us about
institutional special needs plans specifically? Because that's another
segment, like I mentioned. We've seen a lot
of growth there higher than normal MA.
Where do you think is the opportunity there
in terms of its continued expansion in that
segment, continuing to see some of the growth
margins we've seen there.
What what happens there in the next few
years?
Yeah. I'm I I'm really excited to talk
about the iSNP world because we view iSNP
as the real maybe the best embodiment of
SCAN's mission to keep seniors healthy
and independent.
You know, our our Embrace product is
now the largest and fastest growing iSNP in
California,
and
it's delivering markedly better patient experience
to the members who it serves. Right? Facility's
instinct
often is to to call 911 at the
first sign of any any trouble for their
patients,
because it's impossible for them to get the
kind of rapid response they need to keep
their,
you know, the the folks living in their
communities,
at home.
And our ISP
program, which we call embrace
has really developed a better model
delivering care directly into the community available 20
fourseven
there to deliver,
you know, higher level urgent care.
And and even before it gets there to
prevent
exacerbations of chronic illness before they ever happen.
You know, part of the reason we're seeing
that level of growth
is because there's
been,
an increasing recognition from community operators,
that there's an important intersection between health care
and the community,
that keeping folks healthy,
and in their building
is both right for the for those members
and also
important for the economics of their,
operations.
And so we we think where ISNIP will
go in the next number of years is
is continued growth around
community operators who see
who see this vision and want to build
the kind of transformational partnerships with SCAN,
that can that can bring this to their
community. So, you know, for example,
we recently
announced
a partnership with Brookdale Senior Living, where we're
expanding,
across their 33 communities in California and Arizona
and partnering
around how can we keep
their communities healthy in in our iSNP product.
So we hope to replicate that model with
many other operators in the years to come.
Understood. So you foresee continued growth in this
segment. You're partnering and want to continue partnering
with these senior living facilities.
And what was that, statistic you cited, Zach,
about I SNP at the beginning being one
of or the fastest growing for you in
California?
Embrace is the largest and fastest growing I
SNP,
in California.
Fantastic. Well, Zach, as we, wind down on
on time here, you've got the ears of
of a lot of other health plan leaders
listening in from all over the country.
Everyone's, I think, feeling a little bit,
nervous,
excited going into AEP.
So
if you're speaking to them all directly,
any final thoughts, final bits of advice as
we we enter this, this period of the
year?
You know, I think,
historically, plans and and providers have often
seen
ourselves as in competition that that that this
health plan industry is a bit of a
zero sum game. And and we
take a different approach, and I personally believe
that there's
an opportunity to build the kinds of deep
long term partnerships with providers that ultimately result
in better health care and better economics for
everyone. And
that's
the kind of partnerships that we're building
now. We we recently announced our partnership with
Sutter to do just that and think about
how can we co design
health plans and benefits that improve the life
of providers
as well as patients,
and then get really deep into the way
we deliver care to improve outcomes fundamentally for
everyone. And so I would just say that
there's an opportunity to do that for anyone
who operates in this industry
and to think about how we can make
the system stronger as a whole by working
together.
Wonderful. Well, Zach, I really appreciate you taking
the time to chat with us and for
sharing your insights with our listeners. We really
appreciate it. Thank you. I enjoyed the conversation.
Yeah. Likewise. And and to our listeners, if
you'd like to listen to more podcasts from
Becker's, you can visit beckershospitalreview.com.