Sachin H. Jain, MD, MBA

I am leaving #ahip2023 with mixed feelings.

I am feeling gratitude for the team at AHIP for putting on an incredible conference. From Fauci to Jewel—the Convention Center in Portland was abuzz with inspiration and possibility.

I was so excited and jazzed to spend time with colleagues and partners from across the industry—but most especially the great people of SCAN and CareOregon.

The promise and potential of our two organizations coming together as the HealthRight Group has never felt more envigorating.

At the same time, I’m reflecting on the learned helplessness of our industry.

How much we have normalized the abnormal.

The extent to which we believe the only way to fix a broken system is to apply more and more patches in the form of an ever-dizzying array of initiatives and vendors.

The ways in which seemingly hopeful discussions about AI and digitization obfuscate the more necessary dialog about our own responsibility for having created and/or presided over a healthcare system of which few of us are truly proud.

I had many sobering conversations in between sessions in which we grappled with uncomfortable truths:

1) Social determinants of health. While our industry congratulates itself for benefits to address social determinants of health, we must contend with an unacceptable paradox. The sale of these benefits is predicated on expected low utilization. If utilization were higher, we couldn’t afford for the benefits to be as “rich” as they are. Many people under our care who need these benefits aren’t getting them.

2) Consumerism. Let’s finally say what needs to be said about benefit design. High deductible plans haven’t delivered. They’ve left too many people feeling uncovered. And they are often a source of high medical debt—or, worse, people forgoing necessary care altogether. Can we turn back the clock to when people felt insurance was assurance?

3) Health equity. We aren’t doing enough to truly addres health equity. When George Floyd was murdered, we were awash with press releases and donations signaling virtue. More than 3 years later, many healthcare organizations are hiding behind the fact that they don’t have the demographic data to quantify disparities. It is 2023. We don’t have the data? Please.

4) Hucksters. The healthcare gold rush has produced hucksterism that has people selling incomplete solutions that lack heart and patient focus. And worse, we buy them. Theranos was just the most egregious example. We have many, many minor Theranoses predicated on flimsy products built with no resolve.

5) Dehumanization. Healthcare and healthcare organizations have gotten so big that too many people feel powerless and helpless in the face of real issues that need answers now. Our industry’s complex and hard to navigate interface with doctors and patients/members alike exacerbate it. We have normalized the abnormal.

There’s so much to fix. Let’s get home and let’s get to it.

It’s our job to do better.

Today is my first day leading SCAN Group and SCAN Health Plan and I couldn’t be more excited to get started.

SCAN’s founding story is an important one:

In the mid-1970s, Long Beach, CA had one of the highest percentages of residents over the age of 65 in the U.S.

Fed up with the fractured and incomplete network of senior services, 12 elder leaders of the largest senior groups—including Hispanic, Black and Asian groups—worked together to advocate for a more coordinated system of health and social services for older people.

The founders were called the “12 angry seniors” and in 1977, the Senior Care Action Network (SCAN) was borne out of their passion to challenge the status quo. Over the ensuing years, SCAN evolved into one of the nation’s leading managed care organizations dedicated to addressing the needs of aging adults.

Today, SCAN employs over 1100 talented individuals and serves over 220,000 people with a culture of compassion and an enduring focus on helping seniors to age in place.

I couldn’t be more proud to join this amazing team and can’t wait to partner with other likeminded individuals and organizations to drive growth, diversification, and innovation—at a time when the brilliant vision of those 12 angry seniors feels more relevant than ever.

Earlier in my career, I recruited ambitious, early career, high-potential leaders to middle/senior management roles.

They stayed in their roles for 1-2 years building teams and driving significant change.

Their “resume” accomplishments were many—and on the basis of these accomplishments—they were offered significant promotions and executive level leadership roles in other companies.

I was so proud of them.

While a few of these succeeded wildly, many struggled mightily in their new roles—and, for years, I wondered why. With hindsight, the answer seems clearer.

While they had made major motion and progress in a short time—deserving of recognition and interest from other companies—they didn’t live to see what worked and what didn’t work among their decisions.

They didn’t live through many corporate business cycles where intuition about problem-solving and peripheral vision truly develops.

They didn’t live through and adapt to changes in the business environment and leadership.

And so their development was slowed even though their careers had accelerated.

As Leeba Lessin told me, “there are some lessons you can only learn through experience.”

In a world where there is a constant race to the top, being slow at times serves us better (as hard as it can be to sit still sometimes).

The next bigger role and the shiny new promotion doesn’t always serve us best.

There is real value in living with the decisions we make and sticking around long enough to see which were good ones and which ones were mistakes from which we can learn important lessons.

After all, isn’t leadership development really just about honing one’s decision-making and judgment?

Two days ago, a woman approached me as I was taking out the trash. She introduced herself as the sister of my next door neighbor.

Neighbor’s sister: “I understand that you are the president of SCAN.”

Me: “Uhm, yes.” I was nervous about where this might go. Conversations starting out this way mostly go very well but occasionally go sideways fast.

Neighbor’s sister: “Are you guys in Arizona?”

Me: “Yes, we have been in Arizona for two years now. In Phoenix and Tucson. Why do you ask?”

Neighbor’s sister: “Your Embrace team has done an amazing job with my husband. He has dementia and lives in a memory care unit and the weekly visits from Liz, the nurse practitioner, give me a lot of comfort and support. He’s declining. I don’t want to move anywhere that you guys aren’t. Are you in Northern California?”

(Embrace is our institutional special needs plan [ISNP] for home and institution bound patients)

Sometimes we all doubt whether we are making a difference. Whether the words we say and the programs we build truly translate into the difference we set out to make.

When we launched our ISNP two years ago, our teams (led initially by Payam Parvinchiha, MD, MPH, Lisa Hildreth, Benjamin Ware, MD, Alyssa Rios and other great leaders—and now also by Gabe Waterman, MD, MBA, Daniel Croymans, MD, MBA, Sheerali Patel PharmD, BCPS) set out to build something special and different that provided direct care to members with the highest clinical care.

We are deliberately hard on ourselves and need to be even harder on the path to clinical excellence. We have grown quickly and occasionally stumbled. We continue to feel instinctively that we can be even better.

But this random interaction affirmed that we are on path to build and scale a clinical model of care to which every home and institution-bound older adult should have access.

The fact that even one person was making a life decision as profound as moving based on the presence of our health plan and our clinical teams—was as gratifying a feeling as I have had in a long time.

It was also a reminder that critics of Medicare Advantage often don’t see some of the unique innovations that are enabled by prepayment.

Every Embrace patient has access to:

1) an employed nurse practitioner and primary care doctor who visits them on the home on a regular basis (sometimes weekly or daily if necessary)

2) a case manager and/or social worker who facilitates transitions of care and ensures that frail and demented patients don’t spend more time than they need to in hospitals

3) a pharmacist who works consistently to identify opportunities to optimize their medication regimens

4) on-site, in-home diagnostics and specialist consultations to help avoid confusing, unnecessary visits to medical care settings.

It’s hard to understand the difference programs like this make until you see them in action.

Or until your neighbor’s sister says she isn’t going to move to a geography where your plan doesn’t exist.

Happy Diwali to all! Wishing everyone the best this coming year.

We are thrilled to share our news that SCAN is once again a 4.5 Star Medicare Advantage Health Plan—for the 6th year in a row. We are the only 4.5 Star plan in California.

The team at SCAN is consistently excellent and I couldn’t be more proud. STAR Ratings reflect clinical excellence and administrative performance and require the efforts of all SCAN team members and countless provider, vendor, and broker partners.

A huge thank you to everyone who made this possible!

Many companies use non-compete provisions as a means of retaining talent. And some leaders are punitive in enforcing them: “how dare you leave?” they ask.

Our job as leaders is to create work environments that people love and wish not to leave—not create jails people believe they can’t leave for fear of retribution.