Health Care vs. Sick Care: SCAN Health CEO Dr. Sachin Jain on Fixing the System

Dr. Sachin Jain says he got a silent education about healthcare
and medicine around the dinner table from his father, an
anesthesiologist and pioneer in pain management. But he still
wasn’t sold on a career in healthcare until the end of his junior
year at Harvard when he took a course on the quality of
healthcare in the U.S. taught by Dr. Howard Hiatt and (one of
this podcast’s first guest) Dr. Don Berwick.

That decision kicked-off a career where Sachin has packed
experience from nearly every angle of the healthcare industry
into the last 20 years. Immediately following his junior year at
Harvard, Don Berwick offered him a summer internship with the
Institute for Healthcare Improvement (IHI) working on its
Pursuing Perfection Initiative. This provided an opportunity to
visit and study the nation’s best health systems at Don’s side
and opened the door to a tremendous network of national
healthcare leaders.

A few year later, Sachin landed in Washington, DC as Special
Assistant to the National Coordinator for Health IT during the
Obama Administration and then Senior Advisor to the CMS
Administrator (his mentor, Don Berwick). He then jumped back to
the provider side as a resident at Brigham and Women’s Hospital
in Boston for four years, before seeing healthcare through the
pharmaceutical lens as Chief Medical Information and Innovation
Officer at Merck. In 2014, he was recruited to the west coast by
Anthem Blue Cross Blue Shield, where he was CEO of its
subsidiary, CareMore Health, a care delivery system for Medicare
and Medicaid patients, and CEO of Aspire, a large palliative care
provider that was acquired by Anthem in 2018.

In July 2020, Sachin became CEO at SCAN Health Plan, a non-profit
founded as the Senior Care Action Network in the late 70s that’s
now a Medicare Advantage HMO with 220,000 members and revenues
over $3.5 billion.

At SCAN, Sachin has continued his commitment to disrupting the
status quo in healthcare. On this episode of Healthcare Is Hard,
he discussed many of his ideas with Keith Figlioli, including:



Making hospitals less necessary. A few years back,
Sachin was in the running to lead a nationally-known integrated
health system and laughs at himself when he thinks of his final
pitch to the board. He argued for revenues to go down, fewer
beds and facilities, less fee for service revenue, and more
risk-based revenue. While he fully understands how this goes
against everything driving health systems for the past two
decades, it aligns with his fundamental belief that healthcare
needs to focus more intensely on outpatient management of
people with chronic diseases to keep them out of hospitals as
much as possible.


Medicare advantage as a blueprint of Medicare for all.
Sachin says he doesn’t think Americans trust the public sector
to fund and provide healthcare, but he believes people could
get behind healthcare that is government funded and privately
delivered. With elements like a coordinated network,
transparency around quality, incentives for consumer
experience, and rewards for higher participation, he believes
MA could be a solution to full coverage.


Islands of innovation. While Sachin sees lots of
creativity and reinvention around individual verticals and
addressing single diseases, he’s frustrated with the lack of
connective tissue between them and thinks this will get worse
before it gets better. He says the next phase will have to be
focused on connecting all these pieces to treat the full
patient and that it will be incumbent on private markets to
think creatively about deal structure to incentivize it.



To hear Sachin and Keith talk about these topics and more, listen
to this episode of Healthcare is Hard.