2023 NIC Spring Conference Preview
Forget trying to design the perfect healthcare partnership. Now’s the time to stop talking and start doing, according to Dr. Sachin Jain, CEO of SCAN Group and SCAN Health Plan, one of the nation’s largest and fastest growing not-for-profit Medicare Advantage plans.
With a BA, MBA, and MD from Harvard University, Dr. Jain will offer his provocative take on Medicare trends as a keynote speaker at the 2023 NIC Spring Conference (March 1-3). The Friday session will include a panel of experts who will discuss how private pay senior housing operators can tap into Medicare payment models, including Medicare Advantage (MA) plans which are experiencing exponential growth.
As a teaser for the upcoming Spring Conference audience, NIC Chief Economist Beth Mace recently talked to Dr. Jain about the future of MA plans and the partnership opportunities for senior housing providers.
Mace: Can you tell us about a few trends you see in Medicare and how those may impact operators of senior housing?
Jain: There is more scrutiny of the Medicare Advantage (MA) program and that is a good thing. More than 50% of Medicare beneficiaries receive their healthcare services through MA plans. So, I think it’s worth pausing to look at the program and identify some of the opportunities. The areas for improvement fit into three categories. First is risk adjustment, which is a controversial topic. We want to get risk adjustment right because we want to create incentives for healthcare organizations to want to take care of sicker MA beneficiaries, but we don’t want to go so far as to create an arbitrage situation wherein plans are selectively enrolling certain populations because the cost of their medical care is less than what the government will pay for them. We do see evidence of that behavior.
The second major trend is the growth of specialized plans for particular populations. Operators are familiar with Institutional Special Needs Plans (I-SNPs). These plans focus on home, and institution-bound older adults. But there are opportunities to look at specialized plans for other groups, such as those with dementia. For example, SCAN recently launched a product for LGBTQ+ seniors called Affirm. Twenty years ago, it would have been unimaginable to have a specialized plan for that population. But with the consumerization of healthcare, there will be more need for specialized products and programs for patients of a particular kind.
The third trend, more broadly, is the increasing clinical push of MA programs around care in the home. We must be careful and thoughtful about this. A lot of home healthcare is well delivered, and a lot is not well delivered. Senior housing operators need to answer the question around which types individuals are best managed in their buildings. There is an opportunity for operators to clearly articulate the value they deliver to patients and their families. One of greatest challenges is acknowledging the difference between what we say we do and what we do in practice. Every healthcare organization should have a struggle between the words in their mission statements and what they’re actually doing in practice. Too often we don’t leave space for that self-skepticism. You cannot improve until you acknowledge you’re not perfect.
Mace: As one of the nation’s largest not-for-profit Medicare Advantage plans, SCAN’s mission is to keep seniors healthy and independent. Can you tell us about your organization and its mission? Why was SCAN established and when? And how large is it today?
Jain: SCAN was founded in 1977 by a group of racially and gender diverse community activists in Long Beach, California, who believed the future of aging should be oriented around aging in place. They created a coalition of community-based organizations and called themselves the Senior Care Action Network (SCAN). The primary work of the network in the 1980s and ‘90s, was to operate a social HMO, a major CMS demonstration project focused on integrating the social determinants of health to improve healthcare outcomes. SCAN operated the longest running and most successful of all the social HMO demonstration projects. When CMS phased out the project, we turned our sights into operating as a Medicare Advantage plan. And we have been an MA plan for more than 20 years. Over that time, we have grown to serve more than 285,000 Medicare beneficiaries in four states: California, Nevada, Texas and Arizona. We also operate four diversified care delivery divisions: Welcome Health, focused on home-based geriatric care; Homebase Medical for home-based chronic disease management and palliative care; Healthcare in Action, focused on homeless medical care; and myPlace Health, a PACE program in collaboration with Commonwealth Care Alliance. The unifying theme among our divisions is all the different ways to keep seniors healthy and independent.
Mace: SCAN has a specific focus on “reinventing aging.” What does that mean?
Jain: From a clinical strategy perspective one of the most important things that health organizations that serve older adults can do is to take a look at what I call the inflection points in their lives. One point is turning 65 and becoming Medicare and Social Security eligible. Another inflection point is the diagnosis of a chronic disease or the significant progression of a chronic disease, such as diabetes. The third point is a new diagnosis of cancer. And the fourth is the first fall or fracture from a fall. The goal is to look at each inflection point and do more for people at the point of inflection as they transition from curative care and eventually to hospice care. Every organization should be thinking about how to wrap services around the patient and family to prevent or delay those inflection points, or to support people through those points. That’s how we think about our work at SCAN.
Mace: How can senior housing operators partner with value-based care and Medicare Advantage plans?
Jain: We have lived in the space of strategic possibility for a long time. I’ve been around the Medicare Advantage space for many years and there’s always this perfect partnership just within reach with building operators. Then we get stuck on economics, clinical models, organizational charts, and leadership questions. The answer is some version of the Nike saying, “Just Do It.” We need to do something and learn from it. We are not going to get the perfect partnerships on day one. But there is a clear strategic alignment between Medicare Advantage plans and what senior housing operators do. We are both trying to keep our members and residents healthy and independent to age in place. The question we struggle with is how to unlock shared value and achieve regulatory compliance. There are ways to do it. We have seen successful partnerships. But there is a disconnect between day-to-day building operations and the desire at the corporate level to adopt a more strategic approach. The goal is to close the gap between the high-level intent of the corporation and the ground game played at the individual building level.
Mace: You also focus a lot of effort on social determinants of health. Why is this important, what does this mean, and how do you do this?
Jain: The ‘social determinants of health,’ I believe, is a fancy term for poverty. What happens when you’re poor? You cannot get the food you need, pay rent, or keep the lights on. Our model supports patients through specialized programs for their needs in each area.
Mace: Our operators have eyes 24/7 on residents and have the opportunity to shape people’s choices, influence activity levels and socialization, and yet not many senior living properties are doing that with Medicare Advantage plans. How does senior housing fit into the MA paradigm?
Jain: Senior housing fits in from the perspective that it is the coordinator of the lives of building residents. Also, senior housing can play a role to coordinate access to MA benefits that residents may not know how to obtain.
Mace: Recently, there has been criticism of Medicare Advantage plans. Is that criticism likely to slow the growth of movement by seniors to MA plans?
Jain: I think people have spoken. The criticism is at a macro level. Older people are choosing MA plans because they provide distinctive value. I have a Forbes column that takes a critical look at the fee-for-service model. It is not a panacea. There are huge coverage gaps. Some major expenses are not covered. Categories of benefits are not covered, such as vision, dental and hearing. We have an opportunity to continue to fine-tune MA programs. We cannot ignore the fact that 50% of older adults are MA beneficiaries. Much of the federal regulatory system missed the boat on this. I wrote another Forbes article on the idea that government agencies should focus on innovations in the MA program.
Mace: Should senior housing operators be cautious about working with Medicare Advantage plans?
Jain: Caution is one word. Another word is experiment. Create a partnership of whatever variety. You don’t know what you don’t know until you get started. There is so much latent potential around MA plans and senior housing operators. We’re leaving a lot of opportunity to improve healthcare on the table.
Mace: Is there anything else you would like to add?
Jain: We recently announced the creation of the HealthRight Group, the combination of SCAN and CareOregon. Nonprofit community-based health plans need scale to drive sustainability. When we receive regulatory approval, SCAN and CareOregon will come together under the HealthRight Group umbrella. I’d like to emphasize that senior housing operators have the opportunity to partner with community-based health plans. One of our goals is to create partnerships with operators to improve care for Medicare and Medicaid eligible beneficiaries.
Note: Dr. Jain will be the keynote speaker at the 2023 NIC Spring Conference main stage session, “The Trends and Opportunities in Medicare All Operators Should Be Tracking” on Friday, March 3, 8:30-9:30am.
