Latest / Becker’s Payer Issues Podcast / Zack Myers, National General Manager at SCAN Health Plan

Transcript

Zack Myers, National General Manager at SCAN Health Plan · Becker’s Payer Issues Podcast

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  Hello, everyone. This is Jacob Emerson with the
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  Becker's Pay Your Issues podcast.
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  Thrilled today to be joined by Zach Myers,
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  who is the national general manager at ScanHealth
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  Plan. Zach, thanks so much for taking the
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  time to be with me on the podcast
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  today.
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  Yeah. Thank you.
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  So before we dive into everything we wanna
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  talk with you about, Zach, and all the
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  latest going on at SCAN, can you tell
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  us a little bit more about yourself, your
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  background in health care, and what it is
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  that you do at the company?
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  Yeah. Sure. Well, as you shared, I'm SCAN's
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  national general manager. I'm responsible for the performance
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  and operations
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  of our markets across the country, and and
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  we're a growing health plan. We're now in
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  five states, soon to be six,
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  across the country with over 300,000 lives that
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  we are responsible for the care of. You
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  know, I started my career in health care
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  technology. I kind of grew up in it,
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  Jacob. I my family owned a company back
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  in the day called CECity,
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  terribly named business. We could have used scans
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  marketing team, but,
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  we built
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  interesting technology in the early days of healthcare
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  tech that helped primary care physicians measure the
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  way
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  they delivered care and the quality of care
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  they were delivering and then helped them to
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  get paid under the earliest pay for performance
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  programs that CMS,
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  put out.
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  I helped lead the sale of that business
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  to premiere in 2014
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  and then spent really the next decade of
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  my career in the world of Southern California.
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  Senior care.
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  Really devoted to the mission of how to
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  improve the quality of life for seniors. First
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  first at a company
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  called CareMore Health, where I ran their largest
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  P and L for a number of years.
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  And then here at SCAN. So excited to
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  to chat with you about all things
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  payers, providers and and how to improve care
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  for seniors.
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  Yeah. Absolutely. So you've been in the industry
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  for a long time, Zach. It sounds like
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  it's personal for you as well. You've seen
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  a lot of different trends and and different,
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  directions the industry has gone over over the
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  last decade or so. So you you mentioned
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  Skin is going to be expanding into its
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  sixth states. The the company continues to expand
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  into new markets.
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  Talk to us about some of the factors
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  that you see driving future growth for Medicare
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  Advantage right now. There's obviously so many headlines,
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  so many changes we've been hearing about over
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  the last few years within the program.
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  So where do you see SCAN positioning itself
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  to address some of the challenges and the
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  opportunities in what what is, you know, is
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  a very evolving market?
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  Yeah. Yeah. Well,
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  you know, despite all of the various headlines
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  we've seen in the industry, I think the
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  reality is that seniors have really
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  voted for the MA program with their feet.
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  Now we now have more than half of
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  all seniors in the Medicare Advantage program in
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  large part because they've seen the real value
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  proposition right around having access to
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  additional benefits, comprehensive
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  coverage
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  in particular
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  for those seniors living on fixed incomes,
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  who really depend on stable, affordable access to
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  care that's not possible
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  under
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  a Medigap policy or Medicare fee for service
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  alone.
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  You know,
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  I think even in the face of that
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  growth, what we've seen is some real headwinds
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  in the industry,
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  margin compression,
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  changes to the payment model in part because
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  of v twenty eight,
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  and a general decline in national stars ratings,
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  across many plans.
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  You know, most health plans have reacted to
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  that
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  by pulling out of the markets. I think
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  we're going to see hundreds of thousands of
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  seniors
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  lose access to their health plan, this AEP,
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  or really squeezing their provider partners.
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  You know, we've seen real growth in claim
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  denials,
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  increasing
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  use of burdensome prior authorization.
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  And the result is really a vicious cycle.
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  Right? You see
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  a provider's less happy. You see plans pulling
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  back on benefits. The result is those plans
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  have worsening member experience, worsening star scores, and
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  ultimately,
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  you know,
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  the the circle kind of continues. And I
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  think where SCAN
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  as a nonprofit
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  health plan who's been in this industry for
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  decades,
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  we're positioned to take a different approach.
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  We have the opportunity to reinvest our margin
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  back into our members and our provider partners.
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  And our vision is really to be the
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  most preferred partner for providers,
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  and health systems across the country.
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  And what that allows us to do is
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  create a virtuous cycle instead of
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  the sort of downward spiral I was just
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  describing. So so you see fair payment for
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  providers
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  not playing games with claim denials and prior
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  auth, you know, creates better alignment with your
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  groups.
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  The result is a better member of experience
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  and improved STARS performance.
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  You know, at SCAN, we've seen that we've
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  had,
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  four plus star performance for for over a
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  decade in in our core market in California
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  and, ultimately,
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  higher revenue that we can re invert reinvest
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  in member experience and growth. And
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  so we see a different way of approaching
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  the market that will allow us to win
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  in in the face of of all the
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  change in the industry.
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  Does does that make sense, Jake? It it
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  does make sense, and it's it really aligns
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  with everything that we consistently hear both from
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  the hospital leaders and from the health plan
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  leadership pretty much every day at this point,
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  Zach, in terms of the squeezing of profit
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  margins of of providers,
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  the turmoil that everyone is expecting membership wise
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  heading into AEP.
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  But I know, you know, speaking from with
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  SCAN leadership over the years, it's it's really
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  great to consistently hear how the company acknowledges
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  these industry problems and then tackles them head
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  on,
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  and and wants to to fix them. I'll
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  just mention, you know, we the proof point
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  for that from a scam perspective is we're
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  now not really pulling out of any markets.
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  We're expanding into the markets as AEP. And
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  so you're gonna see us sort of with
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  with hopefully market leading benefits,
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  expanding into our sixth state, continue to grow
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  in the states that we operate in. And,
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  so we're excited about that. Yeah. No. It's
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  really great to hear, and it definitely is
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  in contrast to, obviously, a lot of other
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  big players out out there. I wonder you
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  know, I know there's a lot going into
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  just this enrollment period, but if you were
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  looking at the health care landscape in terms
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  of how it's been evolving and how it
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  will evolve over the next three to five
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  years or so,
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  is there anything in particular that stands out
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  when it comes to Medicare Advantage? Any predictions,
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  that you would wanna share? It's
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  hard to predict where this I know. This
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  you know, is it there's so many you
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  know, it's at the whims of CMS in
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  many ways. But, you know, I think we're
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  we're gonna see
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  Medicare Advantage
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  continue to play an important role for seniors
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  and for the government.
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  I think it will evolve in pretty significant
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  ways. I think plans are gonna have to
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  adapt to tighter margins,
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  which is gonna require
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  being very thoughtful about how do you deliver
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  meaningful value to seniors through the right benefits,
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  not gimmicks,
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  and then build the kind of provider partnerships
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  that can actually bend the cost curve and
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  keep patients independent and and healthy, which is,
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  you know, fundamentally
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  our mission.
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  And I think part of that's gonna be
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  the reality of changing technology. Of course, AI,
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  But also, you know, we're seeing real novel
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  medications, therapies, testing modalities.
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  And at scan, we're thinking very creatively about
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  how do you build sort of the care
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  models of the future that can wrap around
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  and support our provider partners
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  to improve quality of life and create savings.
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  But I think that's gonna be a really,
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  like, narrow,
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  line to to tiptoe here over the next
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  few years. As a nonprofit, I think SCAN's
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  pretty well positioned to
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  to lead
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  in in across all of those different changes
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  that I that I just talked about. And,
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  you know, we really wanna demonstrate how mission
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  driven organizations
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  can
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  help set the standard
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  for what Medicare
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  becomes and looks like.
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  Yeah. No. Absolutely. I mean and I appreciate
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  your candidness around that topic as well there,
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  Zach. And I I wonder if we're if
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  we're sticking on the topic of caring for
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  the most vulnerable, and certainly that applies to
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  a big swath of the Medicare
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  population.
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  One area we've really seen a lot of
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  growth, more than traditional Medicare Advantage, in terms
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  of growth over the last few years is
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  within special needs plans.
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  And so can you talk to us about
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  institutional special needs plans specifically? Because that's another
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  segment, like I mentioned. We've seen a lot
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  of growth there higher than normal MA.
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  Where do you think is the opportunity there
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  in terms of its continued expansion in that
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  segment, continuing to see some of the growth
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  margins we've seen there.
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  What what happens there in the next few
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  years?
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  Yeah. I'm I I'm really excited to talk
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  about the iSNP world because we view iSNP
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  as the real maybe the best embodiment of
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  SCAN's mission to keep seniors healthy
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  and independent.
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  You know, our our Embrace product is
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  now the largest and fastest growing iSNP in
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  California,
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  and
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  it's delivering markedly better patient experience
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  to the members who it serves. Right? Facility's
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  instinct
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  often is to to call 911 at the
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  first sign of any any trouble for their
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  patients,
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  because it's impossible for them to get the
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  kind of rapid response they need to keep
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  their,
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  you know, the the folks living in their
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  communities,
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  at home.
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  And our ISP
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  program, which we call embrace
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  has really developed a better model
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  delivering care directly into the community available 20
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  fourseven
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  there to deliver,
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  you know, higher level urgent care.
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  And and even before it gets there to
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  prevent
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  exacerbations of chronic illness before they ever happen.
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  You know, part of the reason we're seeing
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  that level of growth
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  is because there's
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  been,
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  an increasing recognition from community operators,
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  that there's an important intersection between health care
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  and the community,
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  that keeping folks healthy,
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  and in their building
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  is both right for the for those members
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  and also
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  important for the economics of their,
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  operations.
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  And so we we think where ISNIP will
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  go in the next number of years is
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  is continued growth around
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  community operators who see
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  who see this vision and want to build
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  the kind of transformational partnerships with SCAN,
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  that can that can bring this to their
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  community. So, you know, for example,
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  we recently
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  announced
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  a partnership with Brookdale Senior Living, where we're
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  expanding,
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  across their 33 communities in California and Arizona
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  and partnering
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  around how can we keep
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  their communities healthy in in our iSNP product.
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  So we hope to replicate that model with
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  many other operators in the years to come.
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  Understood. So you foresee continued growth in this
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  segment. You're partnering and want to continue partnering
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  with these senior living facilities.
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  And what was that, statistic you cited, Zach,
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  about I SNP at the beginning being one
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  of or the fastest growing for you in
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  California?
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  Embrace is the largest and fastest growing I
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  SNP,
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  in California.
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  Fantastic. Well, Zach, as we, wind down on
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  on time here, you've got the ears of
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  of a lot of other health plan leaders
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  listening in from all over the country.
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  Everyone's, I think, feeling a little bit,
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  nervous,
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  excited going into AEP.
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  So
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  if you're speaking to them all directly,
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  any final thoughts, final bits of advice as
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  we we enter this, this period of the
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  year?
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  You know, I think,
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  historically, plans and and providers have often
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  seen
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  ourselves as in competition that that that this
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  health plan industry is a bit of a
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  zero sum game. And and we
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  take a different approach, and I personally believe
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  that there's
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  an opportunity to build the kinds of deep
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  long term partnerships with providers that ultimately result
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  in better health care and better economics for
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  everyone. And
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  that's
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  the kind of partnerships that we're building
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  now. We we recently announced our partnership with
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  Sutter to do just that and think about
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  how can we co design
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  health plans and benefits that improve the life
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  of providers
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  as well as patients,
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  and then get really deep into the way
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  we deliver care to improve outcomes fundamentally for
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  everyone. And so I would just say that
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  there's an opportunity to do that for anyone
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  who operates in this industry
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  and to think about how we can make
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  the system stronger as a whole by working
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  together.
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  Wonderful. Well, Zach, I really appreciate you taking
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  the time to chat with us and for
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  sharing your insights with our listeners. We really
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  appreciate it. Thank you. I enjoyed the conversation.
• 13:13
  Yeah. Likewise. And and to our listeners, if
• 13:15
  you'd like to listen to more podcasts from
• 13:16
  Becker's, you can visit beckershospitalreview.com.