Latest / Becker’s Payer Issues Podcast / Driving Innovation in Medicare Advantage with Dr. Joe Kimura of SCAN Health Plan

Transcript

Driving Innovation in Medicare Advantage with Dr. Joe Kimura of SCAN Health Plan · Becker’s Payer Issues Podcast

• 0:00
  Hello, everyone. This is Jacob Emerson with the
• 0:02
  Becker's Payer Issues podcast.
• 0:04
  Thrilled today to be joined by doctor Joe
• 0:06
  Camara, who is the chief medical officer at
• 0:09
  SCAN. Doctor Camara, thank you so much for
• 0:11
  taking the time to be with me on
• 0:13
  the podcast today.
• 0:14
  Absolutely. It's a pleasure to be here, Jacob.
• 0:16
  Thank you so much. Yeah. Absolutely. And before
• 0:19
  we dive into everything we wanna talk with
• 0:20
  you about, Joe, can you tell us a
• 0:22
  little bit more about yourself, your background in
• 0:24
  health care, and what it is that you
• 0:26
  do today at SCAN?
• 0:29
  Sure. Absolutely. My pleasure.
• 0:31
  So I serve as our chief medical officer
• 0:33
  here at SCAN Health Plan. And in that
• 0:35
  function, I oversee the development and implementation
• 0:39
  of SCAN's clinical strategy across not just the
• 0:42
  health plan, but also its affiliated medical groups.
• 0:44
  And,
• 0:45
  the my purview is over the clinical quality,
• 0:48
  utilization management,
• 0:49
  the population health care case management, pharmacy, and
• 0:53
  the clinical innovation functions. And so
• 0:55
  for me,
• 0:56
  I'm a primary care physician through and through.
• 0:59
  I trained in primary care internal medicine, did
• 1:01
  my fellowship training in health services research, and
• 1:04
  have focused
• 1:05
  my career really on the design and improvement
• 1:08
  of care, particularly in the outpatient ambulatory care
• 1:10
  system space.
• 1:12
  For the past two decades, I worked both
• 1:14
  as a clinician and an executive,
• 1:18
  really in value based provider organizations.
• 1:21
  Most of my time was spent in Eastern
• 1:23
  Massachusetts at Atrius Health and Harvard Vanguard,
• 1:27
  which was the provider side of the old
• 1:29
  Harvard Community Health Plan. And I served as
• 1:31
  chief medical officer there from '16 to '22.
• 1:35
  And prior to joining SCAN, I actually spent
• 1:37
  three years, within a specialty BBC
• 1:40
  startup,
• 1:41
  serving as chief medical officer for Somatas,
• 1:44
  which was a value based specialty care provider
• 1:47
  in McLean,
• 1:48
  really trying to help patients with chronic kidney
• 1:50
  and cardiovascular
• 1:51
  disease to avoid those downstream complications. So, kind
• 1:55
  of been through the circuit, mostly on the
• 1:57
  provider side, and, we're really excited to be
• 2:00
  in this space here with a health plan,
• 2:01
  thinking about progressive ways to really help our
• 2:04
  members and patients stay healthy.
• 2:06
  Fantastic. Well, we're really glad to have you
• 2:08
  here with us to get your take on
• 2:10
  Medicare Advantage specifically and and where you think
• 2:13
  that program is is going to evolve and
• 2:16
  keep going.
• 2:17
  So let's talk a little bit about that.
• 2:19
  Obviously, it's a MA, it's a very dynamic
• 2:22
  program. It's it's constantly changing. There's lots of
• 2:25
  headlines all the time,
• 2:26
  about the state of the market. And we
• 2:28
  continue to see SCAN,
• 2:30
  scale,
• 2:31
  there are lots of expansion into new markets.
• 2:35
  So from your perspective, Joe, what are some
• 2:37
  of the factors that you see driving
• 2:39
  future growth in the MA space?
• 2:42
  And how is SCAN position positioning itself,
• 2:45
  to address challenges and opportunities in in what
• 2:48
  we know, like I said, is a very
• 2:50
  evolving and dynamic
• 2:51
  market?
• 2:53
  That's a great question, Jacob. Thanks.
• 2:56
  So
• 2:57
  I I think in the Medicare Advantage space
• 2:59
  in particular,
• 3:01
  there is
• 3:02
  the fact that health care for our seniors
• 3:05
  and older Americans
• 3:06
  really,
• 3:07
  does get more complex,
• 3:09
  gets more complicated, and our delivery system continues
• 3:12
  to be
• 3:14
  fragmented. Although, I know coming from the provider
• 3:17
  side, there's lots of efforts to try to
• 3:19
  streamline and make things more efficient and coordinated.
• 3:22
  But the the reality is that we're still
• 3:24
  in a space where it becomes more and
• 3:26
  more challenging, the more complex your health becomes.
• 3:29
  And
• 3:30
  where I think MA truly does deliver better
• 3:33
  value than the sort of the traditional fee
• 3:34
  for service Medicare chassis.
• 3:37
  Traditional Medicare often
• 3:39
  exposes seniors, I would say, to sort of
• 3:41
  higher out of pocket costs and some of
• 3:44
  the things that we know are equally as
• 3:46
  important
• 3:47
  to sort of the traditional clinical care like
• 3:49
  vision, hearing, and dental,
• 3:51
  are all sort of elements of day to
• 3:53
  day health care for seniors that,
• 3:56
  are sort of if wrapped together and coordinated,
• 4:00
  actually provide
• 4:01
  better outcomes for everyone.
• 4:03
  MA does allow that kind of innovation, right,
• 4:06
  by offering that coordinated integrated care,
• 4:08
  and pushing
• 4:10
  all of us to be focusing on not
• 4:12
  just what we're doing, but what are the
• 4:15
  outcomes of what we're doing? How did those
• 4:17
  outcomes get better?
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  And here at SCAN, I'd say that we're
• 4:21
  really trying to leverage that flexibility,
• 4:24
  to try to get the right benefits, the
• 4:27
  right clinical care, the right coordination
• 4:29
  put in place, to be sure that we're
• 4:31
  meeting seniors where there are, as well as
• 4:34
  trying to simplify the overall health care experience
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  for our members, as well as for our
• 4:38
  provider partners.
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  And you you alluded to the fact that
• 4:42
  sort of there are some challenges right in
• 4:45
  the landscape ahead. And
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  as we look around,
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  there are a lot of
• 4:50
  folks that are hesitating around Medicare Advantage and
• 4:54
  sometimes
• 4:55
  backing off a little bit. But for us
• 4:57
  as a non for profit
• 4:59
  health care plan, we do believe that,
• 5:02
  we have an opportunity,
• 5:04
  right, to really
• 5:05
  showcase what we can do, when we have
• 5:08
  this kind of coordinated care and coverage benefit
• 5:12
  ability, that we can invest
• 5:14
  more in that better care, invest in more
• 5:17
  stable and comprehensive benefits,
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  and invest in being sure that we are
• 5:21
  there to provide that long term value for
• 5:24
  our members.
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  And we could do it because of the
• 5:27
  ability that as a non for profit,
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  we're thinking about the long game. We're not
• 5:31
  there necessarily for short term profits.
• 5:34
  And it has allowed us at SCAN to
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  to really do a lot of innovative things.
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  For example, you know, we've we've been out
• 5:42
  sort of at the forefront
• 5:44
  of launching,
• 5:46
  first of their kind plans around personalized care
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  for,
• 5:50
  women, inspired our inspired plan for women or
• 5:53
  our firm plan for the LGBTQ
• 5:55
  plus seniors and the allied plan for our
• 5:58
  Asian senior population. So,
• 6:00
  again, right, that that creativity and the flexibility
• 6:04
  that MA provides,
• 6:06
  coupled with our commitment and our mission as
• 6:08
  a nonprofit,
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  really allows us to be bullish about the
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  fact that we can continue to serve more
• 6:14
  and more members across this country,
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  to be able to provide that kind of
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  care where it's needed, whether it's in the
• 6:21
  home, in the community, or even virtually. So
• 6:23
  super excited about the opportunity and really pushing
• 6:26
  forward to try to make sure that,
• 6:29
  we can continue to drive improvements and health
• 6:32
  outcomes for seniors.
• 6:34
  Absolutely. And to your initial point, Joe, I
• 6:37
  mean, we've seen study after study,
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  and certainly on the ground experience like yours
• 6:41
  show that MA, it offers lower out of
• 6:44
  pocket costs, better benefits,
• 6:46
  better outcomes across many different,
• 6:49
  spaces
• 6:50
  for seniors. So your point is well heard.
• 6:53
  But I wanna follow-up on on something you
• 6:55
  mentioned in terms of SCAN really does stand
• 6:57
  out among the in the MA industry in
• 6:59
  terms of very specific and personalized
• 7:02
  plans for for certain populations,
• 7:05
  Asian Americans, LGBTQ,
• 7:07
  older
• 7:08
  adults. So, you know, so much of your
• 7:10
  career has been based in in innovation and
• 7:12
  value based,
• 7:14
  care. So as you lead scans efforts in
• 7:17
  this space,
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  how do you envision the role of technology,
• 7:20
  data analytics in in shaping that more personalized
• 7:23
  and effective care delivery for your,
• 7:26
  now more than 300,000
• 7:27
  members?
• 7:28
  Yeah.
• 7:29
  It's a great question, Jacob.
• 7:31
  And and, sort of the the side that
• 7:33
  perhaps I missed in my intro bio is
• 7:36
  that I'm actually,
• 7:37
  boarded in internal medicine, but also boarded in
• 7:39
  clinical informatics. So technology and data analytics
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  are a core part,
• 7:45
  of why I think healthcare is heading forward.
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  And in this twenty first century, realizing we're
• 7:51
  twenty years into it now, but,
• 7:53
  we're really in a spot where there's some
• 7:55
  exciting new capabilities,
• 7:57
  addressing some of the challenges. Right? Of How
• 8:00
  do we actually make sure that not only
• 8:02
  the reliability
• 8:04
  of getting evidence based care,
• 8:06
  is happening more consistently across our population,
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  but to your point around how do you
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  then personalize that care, so it doesn't feel
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  like we're doing cookbook or recipe based medicine
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  on everybody. Because every every member, every
• 8:21
  person has unique challenges, a unique set of
• 8:24
  circumstances that they're dealing with. Even if there's
• 8:27
  they're sort of all working and trying to
• 8:29
  optimize the care for common disease or common
• 8:32
  conditions. So I think technology and analytics are
• 8:35
  really critical enablers of this kind of personalized
• 8:38
  coordinated experience. And we're a strong believer at
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  SCAN that the technological abilities that we bring
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  forth are gonna be foundational
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  for being able to provide that kind of
• 8:49
  care,
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  going forward. And,
• 8:52
  again, there's a lot of hype, Jacob. And,
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  you know, and I think I've having heard
• 8:55
  prior podcast as well too, I think everyone
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  recognizes,
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  you know, artificial intelligence, all the advanced analytics
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  capabilities.
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  There's a lot of flash that is happening
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  within our industry.
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  And it's really, really important to make sure
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  that, you know, we're not chasing sort of
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  that Gartner
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  sort of early part of the hype cycle,
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  but we're really trying to target using the
• 9:19
  right technology
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  at the right time to match the care
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  and support with the members and patients that
• 9:25
  really need it. And there's an eye towards
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  trying to use that technology
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  to simplify,
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  to,
• 9:31
  expediate the care, and try to make sort
• 9:34
  of care more effective for our members, but
• 9:37
  also our provider partners, for our workforce.
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  And everyone sort of involved wrapping around the
• 9:43
  care for those patients.
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  And technology does enable that. Right? So our
• 9:48
  our capability of using data, using the ability
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  to sort of say, you know, you have
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  one cohort of patients, say they have congestive
• 9:57
  heart failure, dementia, or even diabetes,
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  but within that
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  seemingly
• 10:03
  homogeneous group, you have a lot of different
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  sort of
• 10:08
  that data analytics can help surface and make
• 10:11
  it more efficient and more
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  effective in terms of how care teams,
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  including those on our side at SCAN, but
• 10:19
  also collaborating with our network provider partners, can
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  really wrap around the services
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  where and when it's needed, whether it's in
• 10:26
  the home, on the street, in the clinic,
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  or even virtually. And,
• 10:30
  that kind of capability
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  was hard to do. Right? Definitely hard to
• 10:34
  do twenty five years ago when we're all
• 10:36
  on paper charts,
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  but it makes it a lot easier today,
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  when you've got these kinds of ability to
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  interchange and exchange that data,
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  and information
• 10:47
  across the network of providers.
• 10:50
  And, you know, I would say that the
• 10:53
  virtual capability that we're seeing post COVID,
• 10:56
  continues to make sort of, if I could
• 10:59
  say, sort of open up opportunities
• 11:01
  to try to really improve access and care,
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  for patients and members who are in sort
• 11:06
  of isolated areas,
• 11:09
  that perhaps aren't being served as well by,
• 11:12
  the providers in the community, or honestly, the
• 11:15
  providers are overwhelmed. Right? We're seeing that a
• 11:17
  fair amount,
• 11:18
  in terms of access issues,
• 11:21
  across the board. And when we think about
• 11:24
  that virtual type care though, we do need
• 11:27
  to keep in mind that we need to
• 11:29
  make sure that that system works with our
• 11:31
  older adults in mind.
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  So we at SCAN have also invested in
• 11:35
  parallel, right, to really push digital literacy, digital
• 11:39
  support to make sure the tools are as
• 11:41
  accessible and easy to use.
• 11:44
  And the last part of your question, Jacob,
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  I think was around data analytics. And this
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  is sort of an area that's dear to
• 11:50
  my heart around population health.
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  And
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  the idea of
• 11:56
  enabling proactive world class care is something that
• 12:00
  I've always been super, super passionate about. And
• 12:02
  as a primary care clinician, it feels like
• 12:05
  that's our raison d'etre, right, to really be
• 12:08
  at that place where I can help our
• 12:10
  patients and members
• 12:12
  prevent that hospitalization,
• 12:14
  prevent that rapid disease progression,
• 12:17
  prevent,
• 12:18
  sort of the aspects of,
• 12:21
  mental health challenges from isolation.
• 12:23
  Because if I can detect it sooner and
• 12:26
  know who is at risk, it gives me
• 12:29
  a chance to intervene
• 12:30
  probably with a sort of more efficient type
• 12:33
  intervention, but also a more humane intervention. Because
• 12:37
  when those complications happen, we all know, we
• 12:40
  see it all the time,
• 12:42
  it is wonderful to provide world class care.
• 12:45
  But at that time, you're kind of really
• 12:48
  behind the eight ball, and you're chasing to
• 12:51
  try to rectify situation instead of truly preventing
• 12:54
  it. And I think there's no one in
• 12:56
  the world that would argue that if we
• 12:57
  could just,
• 12:59
  you know, hold true to our adage of
• 13:00
  an ounce of prevention is worth more than
• 13:03
  a pound of a cure,
• 13:04
  it really does make this place,
• 13:07
  a lot better for all of us in
• 13:08
  terms of reducing suffering. And I think data
• 13:11
  analytics become and form the foundation
• 13:13
  of enabling us to be able to do
• 13:15
  that much more efficiently and effectively.
• 13:18
  Certainly. Certainly. And, you know, speaking of proactive
• 13:22
  care, let me let me spout off a
• 13:24
  stat to you that I know you're familiar
• 13:25
  with,
• 13:26
  and certainly, I would imagine most of our
• 13:28
  audience is familiar with it. Around 10,000 Americans
• 13:31
  a day are aging into Medicare.
• 13:34
  We expect that that number to keep growing,
• 13:37
  in terms of the overall ratio there. So
• 13:41
  how do you how how does SCAN how
• 13:43
  how are you thinking about that? How are
• 13:44
  you preparing for that, navigating,
• 13:47
  what's already here?
• 13:49
  And from your perspective, given what we were
• 13:50
  just talking about, Joe, in terms of population
• 13:53
  health and data analytics, how do you continue
• 13:55
  to to view where the health care landscape
• 13:58
  is gonna change over the next three to
• 13:59
  five years when it comes to meeting this
• 14:01
  demand for senior care?
• 14:04
  Yeah. It's a great question, Jacob, and something
• 14:06
  that definitely we think a lot about.
• 14:09
  And,
• 14:10
  you know, the the the demand side there
• 14:13
  with the 10,000
• 14:14
  patients sort of entering into Medicare,
• 14:17
  is coupled with the similar stat that I
• 14:20
  I know that you're also familiar with where,
• 14:22
  you know, we have a lot of our
• 14:23
  workforce
• 14:24
  stepping away, early retirements, folks sort of stepping
• 14:28
  away from direct care provider capabilities. And so,
• 14:32
  we're facing a little bit of a storm,
• 14:34
  right, going forward to say increasing need, decreasing
• 14:35
  capacity to care for, the
• 14:40
  the need.
• 14:41
  But also, I'd add that third bit, which
• 14:44
  says, medical science is advancing. So guess what?
• 14:46
  We have more effective treatments available today to
• 14:50
  really change the,
• 14:52
  trajectory of some of these clinical conditions that,
• 14:55
  again, in the past used to be much
• 14:57
  more much more difficult to manage effectively. And
• 15:00
  I think chronic kidney disease is one great
• 15:03
  example of that with, the new medications that
• 15:06
  are now available.
• 15:07
  And I do think that this is where
• 15:10
  we do need to partner,
• 15:13
  very strongly with our provider partners,
• 15:16
  and try to figure out how do we
• 15:18
  bring the strength of a health plan, with
• 15:21
  the strength of the provider groups to really
• 15:23
  try to to thread this needle of making
• 15:26
  sure that the members
• 15:28
  that really have the needs that,
• 15:31
  are paramount,
• 15:33
  overall, not just from an experience perspective, but
• 15:36
  clearly from a health outcomes perspective,
• 15:38
  get the types of care that they need
• 15:40
  despite the fact that access is challenging,
• 15:43
  everywhere that we look. And so, you know,
• 15:46
  we've
• 15:46
  announced a couple of sort of partnerships with
• 15:50
  large groups like Estrana and Sutter Health here
• 15:52
  in California, where we're really trying to figure
• 15:55
  out how do we work together,
• 15:57
  to try to address those kinds of demand
• 16:00
  and capacity
• 16:01
  challenges.
• 16:02
  But on top of that though, I mean,
• 16:04
  as a primary care clinician, I would say
• 16:06
  there's another aspect here that's really important for
• 16:09
  us, and that or it's really pushing,
• 16:13
  our ability to be able to help and
• 16:15
  coach our members,
• 16:17
  to be able to be as effective as
• 16:19
  possible as they're navigating
• 16:21
  through. And, you know, we think about our
• 16:23
  care coaching programs,
• 16:25
  for our SCAN inspired members,
• 16:28
  offers a lot of personalized one on one
• 16:30
  coaching to tackle
• 16:31
  many of the primary concerns of our members.
• 16:34
  And again, these kinds of programs, when you
• 16:37
  have activated
• 16:39
  engaged and educated members,
• 16:42
  it it enables sort of that member to
• 16:44
  become an active role of the care team,
• 16:47
  and therefore, also,
• 16:49
  become more effective agents of their health care.
• 16:52
  And, again, I think as we're looking at
• 16:55
  health plan and providers as two different arms,
• 16:58
  I do think our members provide yet a
• 17:00
  third arm, right, of us being able to
• 17:03
  work together,
• 17:04
  to try to,
• 17:06
  address some of the challenges that we're facing.
• 17:09
  And it is really, really,
• 17:11
  a challenge that, again, technology, you know, referencing
• 17:13
  our prior conversation,
• 17:15
  also begins to help us with. Because
• 17:18
  in the past, I would say that information
• 17:21
  was
• 17:22
  more sequestered, I would say, in the care
• 17:25
  delivery space overall.
• 17:27
  But with the information, with the kind of
• 17:29
  tools that are available to the general public,
• 17:31
  you know, health care information is democratizing. And
• 17:34
  that is enabling our members and our patients
• 17:37
  to be much more informed around what they
• 17:39
  should be getting, when they should be getting
• 17:41
  it, how they should be getting it, and
• 17:43
  how they prefer. And,
• 17:45
  we wanna empower our patients and our members
• 17:47
  to really be that kind of strong agent
• 17:50
  and advocate for their care. And I think
• 17:52
  all of it becomes important to address the
• 17:54
  challenges that you mentioned.
• 17:56
  Absolutely. Well, exciting things ahead,
• 17:59
  in the in the senior care space, and
• 18:01
  it'll be fascinating to watch scan continue to
• 18:04
  innovate there.
• 18:05
  Before we go, Joe, what else are we
• 18:07
  missing? You got a lot of health plan
• 18:10
  leaders and and MA leadership listening in from
• 18:12
  from all over the country. What do you
• 18:14
  wanna share with them? Any any final bits
• 18:16
  of advice, you'd offer?
• 18:18
  Yeah. No. Thank you for that opportunity. And
• 18:20
  thank you again, right, for this chance to
• 18:22
  actually speak with you and, to to share
• 18:24
  my 2¢ here.
• 18:26
  I get that at two comments.
• 18:28
  One is that, again, acknowledging where we're at
• 18:31
  today
• 18:32
  with the complexity
• 18:34
  and
• 18:35
  the fragmentation
• 18:36
  that just exists in health care,
• 18:39
  really to
• 18:40
  try to be as straightforward as possible in
• 18:43
  terms of keeping that member experience at the
• 18:45
  center of everything.
• 18:47
  We try to push greater
• 18:49
  performance in terms of clinical outcomes or other
• 18:52
  kinds of KPIs and metrics,
• 18:54
  and that can sometimes drive,
• 18:57
  more complexity.
• 18:59
  And,
• 19:00
  we like to say that complexity isn't the
• 19:02
  sign of sophistication.
• 19:04
  It's more signal that perhaps we lost sight
• 19:07
  of what we're trying to do and who
• 19:08
  we're trying to serve. So first point would
• 19:11
  be, again, to really, really keep laser focused
• 19:14
  on that member experience.
• 19:15
  And
• 19:17
  the second point, probably as a corollary to
• 19:19
  that, Jacob, is that,
• 19:21
  we do believe that's the next revolution
• 19:24
  in terms of digitalization
• 19:26
  of health care,
• 19:27
  really comes with the interoperability
• 19:30
  coming into its own. And I think as
• 19:33
  we're seeing,
• 19:35
  the new sort of capabilities
• 19:37
  really start to open up a more freer
• 19:39
  flow of data and information across health plans,
• 19:42
  providers, and patients,
• 19:44
  there is a tremendous
• 19:45
  opportunity here to reduce that friction, eliminate the
• 19:49
  waste, and make room for real collaboration. So,
• 19:53
  the second piece would be to keep an
• 19:55
  eye on that interoperability
• 19:57
  coming and
• 19:58
  be ready to be able to jump in,
• 20:00
  and be more effective partners in connecting,
• 20:03
  our care across all the different domains. Because
• 20:06
  I think it's gonna be an exciting,
• 20:08
  window coming forth.
• 20:10
  Wonderful. Well, doctor Kimura, thank you so much
• 20:13
  for taking the time to sit down with
• 20:14
  us and for sharing your insights with our
• 20:16
  audience. We we really appreciate it.
• 20:19
  Absolutely, Jacob. It was a privilege, and thank
• 20:21
  you so much. Yep.
• 20:23
  To our listeners, if you'd like to listen
• 20:25
  to more podcasts from Becker's HealthCare, you can
• 20:27
  visit beckershospitalreview.com.