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.