Latest / Becker’s Payer Issues Podcast / Senthu Arumugam, Chief Commercial Officer at SCAN Health Plan

Transcript

Senthu Arumugam, Chief Commercial Officer at SCAN Health Plan · Becker’s Payer Issues Podcast

• 0:00
  This is Laura Dirda with the Becker's Healthcare
• 0:02
  podcast. I'm thrilled today to be joined by
• 0:04
  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.
• 12:30
  Laura, it's my pleasure. Thank you for taking
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  the time.