Sachin Jain: Everyone wants to feel like they belong. Everyone wants to see themselves represented in your materials. And the only way you know that is if you've lived your life seeing that you weren't represented. It gets very hard sometimes for people who are part of an in group, so to speak, to really recognize what it feels like to be a member of an out group.
And so the power of having an LGBTQ plan. And I'll let you know a little secret. There's a lot more we can do than we're currently doing to serve that population. But even just having a plan that has your sexuality represented is transformative.
Matthew Weinstock: That was Dr. Sachin Jain talking about the role health equity can play in reaching underserved populations. Jain, who is president and CEO of SCAN Health Group and Scan Health Plan, has been a longtime advocate of advancing health equity across the industry.
In fact, over the past few years, Scan has launched health plans tailored for underserved populations. The company also holds leaders accountable by linking executive bonuses to health equity outcomes.
In this podcast, Jain and Oliver Wyman's Travis Kistler discuss how the industry can improve its performance around health equity, including measuring the return on investment. They also delve into what Jain often calls a leadership crisis across the industry.
The Oliver Wyman Health Podcast is brought to you by the global management consulting firm Oliver Wyman.
For more insights on the business of transforming healthcare, visit our online publication, health.oliverwyman.com and now let's pick things up with Jain reflecting on how and why he's so passionate about health equity.
Sachin: I grew up as an Indian American in Northern New Jersey. And as strange as it may sound today, there weren't a lot of us back then. There's obviously a lot of Indian Americans in New Jersey now. My earliest memories as a child are actually like, feeling like I was the other and that I wasn't necessarily part of a group. And so social dynamics as it related to inclusion were just an integral part of my early wiring. And I'll say throughout my career,
I've always been looking at who's included and who's not included, who's at the table, who's not at the table. In health care, I would say we have a lot of people who are not necessarily represented in key conversations in this country when you start to dig into the data. And I remember sitting in a lecture with Joe Bettencourt, who is now the president of the Commonwealth Fund, but was an early health disparities researcher, and just looking at the fact that for years it was just accepted that there would be different rates of heart attacks in certain populations, that there would be different incidences of diabetes in different populations. And the healthcare system barely acknowledged it.
I kind of got motivated around the notion of not just studying disparities, but actually working to solve them. And undergrad, med school, and now at scan, worked with the homeless population, which is, I think, frankly, one of the biggest health equity problems, where people have major under treated or untreated behavioral health issues, addiction issues.
Also thinking about communities here in Southern California, which is one of the most diverse places in the country, who, you know, were not part of the health care story in this geography. And so we've built, you know, I think a bunch of plan offerings in Southern California at SCAN focused on the Asian population, focused on women, focused on the LGBTQ population. Part of the mission that I'm on right now is to show that health equity can be good business too.
Travis Kistler: Yeah, I think that's very powerful along the lines of like a good business decision, you know, just a couple months ago, we were at Oliver Wyman's Health Innovation Summit. 300 executives we polled, 74%, said health equity is more often a PR strategy than a care strategy. Why do you think the industry feels that way?
Sachin: Yeah, and thanks for having me. And also we had a big room that wasn't full on this topic. And so the reality is there's a lot of performative leadership in healthcare over the last five years. Coming off of George Floyd. Companies said things because they felt like they had to say things. They did things because they felt like they had to do them. But when attention moved away from the issue, so did the investment, so did the focus. You saw chief health equity officers appointed and vanished within two or three years. The title almost doesn't exist in any health organization. The agendas that they were pursuing have almost vanished as well. I think it says a lot about the state of US Healthcare leadership. Some would more charitably say, well, there's so many other problems, so many areas of focus. That is a more charitable interpretation. But I also think that we have major problems to solve. What I want to make sure I say out loud is sometimes health equity becomes the whole agenda, and it shouldn't be because the system is broken for everyone. And I think we do need to fix the system for everyone. And I think sometimes organizations can get really distracted focusing on the problems of the few instead of the many. And I would say that these are false dichotomies that we create. We've got to do both. We've Got to solve the specific problems of specific populations. And we need to make the healthcare system easier and better to navigate for people who need it.
Travis: Yeah. It's interesting. We also hear often one of the biggest barriers is executives are saying, well, the ROI isn't clear. Do you buy that?
Sachin: Yeah. I mean, a lot of it is how you measure ROI. I think it comes back to one of the biggest challenges in US Healthcare is that we've taken this expression, no margin, no mission, and taken it to an ugly extreme. We're no longer asking ourselves what the mission is and whether the mission is even just in the first place. I do think that there is work to do to reprogram healthcare leaders who say, what's the roi?
Just to use the annoying kind of phrase that people kind of sometimes chant and actually say, what is the right thing to do? Yeah. What is the right thing to do? What is the common sense thing to do? What is the radical common sense thing to do? And I think if we can kind of get people thinking more in terms of being good humans who do the right thing, rather than bots who are always focused on making the accounting ledgers work.
Travis: Yeah, I do hear this is often a lot. It's too much. But I think in our current world, we know that constraints, once embraced, can drive innovation. So how has, for you, using equity as a design constraint, or if you will, design priority, changed your approach at SCAN with respect to products, care models, partnerships, what have you?
Sachin: I'll take it back to what I said about my childhood feelings of otherness. Everyone wants to feel like they belong. Everyone wants to see themselves represented in your materials. And, you know, the only way you know that is if you've lived your life seeing that you weren't represented. It gets very hard sometimes for people who are part of an in group, so to speak, to really recognize what it feels like to be a member of an out group.
And so the power of having an LGBTQ plan, and I'll let you know a little secret. There's a lot more we can do than we're currently doing to serve that population. But even just having a plan that has your sexuality represented is transformative. It tells people that you actually care about them. You see them, you recognize who they are and want to adapt your service offerings to address their needs. And when you don't have that, you're just like everybody else.
And so I think what's been fascinating, and I'm kind of tickled by this sometimes, is when we started the Affirm product, we thought you know, we were doing this to be a good company to make a statement, so to speak. But several years into this product, we have more than 3,000 members enrolled in it. 3,000 members is more than a lot of startup MA companies have in their membership roles. So this one product has really attracted and spoken to a lot of people.
More importantly, and this is a really important point, Travis, there are so many LGBTQ executives at Health Systems. So when we actually go and talk to them and say, we have this plan, some of them will say, that's really cool. We want a contract with SCAN. I won't name the systems, but there are several systems that actually wanted to partner with us because we have an LGBTQ plan, because we have a women's product. And people look at other health plans and their generic offerings and they say, you don't really speak to me. You're a commodity. And we are decommoditizing ourselves by actually focusing on special populations.
Travis: I think healthcare often feels behind the curve in consumer personalization. What's the difference between this, in your mind, with health equity and consumer personalization? Or are they really the same thing? Because you're finally getting that Venn diagram aligned.
Sachin: You know, there's the consumer personalization piece of it, and then there's really the rigorous outcomes measurement piece of it, and you've got to do both. You can't do one or the other. It's one thing to say you're an LGBTQ plan, and this is what I say to my team all the time, but let's prove that we are. Let's prove that some health outcome actually moved, some meaningful health outcome moved. We're not there yet. And that's the work for the next couple of years. Candidly, Travis.
Travis: Yeah, I think that's obviously fascinating in terms of, you know, how you start to measure what matters. The other thing, too, is now we think about scan. What does a day to day look like? It's not just that you're launching these products. It's not that you're just like, you have the banner and you have the stuff out there on a day to day, do people think differently? Do you speak? Engage? Do you decide differently as an organization?
Sachin: We've taken the company on a pretty major change journey over the last five years. We no longer call our employees employees. We call them rebels.
Travis: That's great.
Sachin: We harken back to our origin story, which is of the 12 angry seniors, the group of activists in Long Beach, California, who got together and said, we want to age in place. And then Part of that is starting to show up like you're frankly disgusted by the broken status quo of the US healthcare system. It's the status quo we all experience as patients, but then when we walk into our executive offices, we toxically, positively, just kind of treat like it's just another day at the office.
We celebrate our great customer service, even though there's thousands of patients in our networks who don't have access to the care that they need in a timely way.
Travis: Yeah.
Sachin: So we've actually flipped the script. We've started talking about our problems in a way that I think most healthcare companies don't. We actually put out an advertisement saying that health insurance is broken. That was the tagline of our national advertising campaign. And we didn't say scan has it right. We just said we see it and we're trying to fix it. Doesn't mean that we are fixing it, that we have fixed it. It just means we're trying to fix it. If you actually look at some of the chatter on social media about that advertising campaign, I think a couple of executives from other companies were really upset. They said the whole system is broken. I am so tired of the whole system is broken hypothesis which frees you of responsibility for fixing the things that you are personally responsible for actually being broken.
Travis: Exactly.
Sachin: Tell you something I'm really proud of at the company right now. Our new head of member experience, Trish Cox, old colleague from Anthem, came out of retirement to come work with us just out of a sense of calling and mission. She said it's crazy that we're putting 85 year olds in phone trees. So, you know, if we have a member who's 80 or older, they're going to immediately get routed to a person, period. Full stop.
Travis: Yeah.
Sachin: That's what we call radical common sense. That's the kind of thing that again, every company in America could be doing today. But instead we hide behind, no margin, no mission. We hide behind we've got to cut cost out of the system and do the things that companies have to do. You can't both say you're in the human services business and then both say that you're going to like, cut corners to serve those humans in places that doesn't make sense. To cut corners.
Travis: Yeah, I think that's powerful. Well, we have to talk about briefly AI. We know clearly, with AI proliferating across healthcare, how do you see AI as a threat and potentially an enabler to equity?
Sachin: Here's my big concern about AI. At the end of the day, the people who are kind of imagining the AI revolution in health care see nothing in healthcare other than a set of transactions. And they're like, I can make these transactions better and more efficient by using an LLM instead of using a human. It misses the point.
So much of healthcare is not that. And I think we've had a dangerous commoditization of care over the last three decades where we've stripped people of their professional impact and have kind of made nurses equal to Doctors, equal to PAs, equal to community health workers in search of the margin and have lost search of the essence. And the next version of that is going to be when the human gets replaced by the AI. And it may give you the right answer, it may give you the right cancer diagnosis. But the question we have to really ask is like, will it give you that support?
Will it give you the human connection? Will it give you the sense of confidence and trust that you're getting the right answer and you have a person in your corner who's got your back?
Travis: So maybe the flip side of this also is not only are we improving equity for our members, but it actually helps our rebels, our colleagues, achieve highest and best use and those who play a role in the system to ultimately be their most human selves in helping to deliver care. Are you feeling that or seeing that?
Sachin: Look, it's a tough balance. So, like, let's just take, you know, the ambient dictation and the documentation burden in US Healthcare on the surface, if you can kind of take the documentation burden away from the nurses and the doctors who spend most of their time documenting, and actually give them the time and the space to see the people and be human for them. Wonderful. But here's where I see this going next. We're going to say, you know what, the nursing ratios of 4 to 1 don't make any sense in a world that's enabled by AI. So let's make it 8 to 1, and then the AI gets a little better and let's make it 16 to 1, and then we'll be right back to where we were, where people are being treated like they're cattle being carted around the US healthcare system.
And that's what I'm worried about. That's why I think this leadership crisis that I refer to so often is important. We have to stay centered on our purpose. We have to stay centered on our mission. We have to have some things that are okay and some things that are not okay. We have to have boundaries. I'm not convinced that a lot of the leadership compass and US Healthcare has those boundaries, conditions, that clear set of what we will do and what we will not do.
That is really clarifying for organizations, for leadership teams, for boards. I think every organization that's thinking about this AI journey has to make that list of what they will do and what they won't do. And then they have to revise that list every year as kind of capabilities become better and clearer.
Travis: You've talked quite a bit about your goal to become a scaled mission driven nonprofit national payer. And now listening to you talking about the importance of leadership, is that the problem you're trying to solve? But I think you just answered my question. It sounds like you're trying to present an alternative out there that's really guided by the right priorities in making decisions.
Sachin: We're in a David versus Goliath battle for the soul of American healthcare. And I'll tell you, Goliath is winning and David's losing. The story of David and Goliath is ultimately about an underdog kind of beating an overdog. And I'm just telling you, like that's the work we have to do right now. We have to be scrappier, we have to be more human centered.
We're coming off an annual enrollment period where we grew by more than 30%, 100,000 new members as of today, and more and more coming. And that I think is a statement that in favor of David. But we're just getting started in this battle candidly, and we need more allies and we need more organizations that think like this. But we have to move out of this administrative mindset and move into a leadership mindset.
Travis: When you sort of line all that up, it sounds a lot like the preface to a disruption event. Is that possible? When we talk about will David win out against Goliath? What would need to happen for that to change?
Sachin: Everything needs to boil over a little bit. But I will tell you, everything is boiling over a bit.
Travis: Yeah.
Sachin: There are signs of major discontent among American patients, American clinicians. If you look for them, the seeds of revolution are everywhere. The question is, are we going to create the conditions for that revolution to really come together? I wasn't born yesterday. I know that major change in healthcare comes more by accident than by deliberate action.
Teddy Kennedy passing was the critical event in the aca. Fundamental health reform gets contemplated in every presidential administration and gets passed on to the next and passed on to the next and passed on to the next. But I do think, whether it's direct primary care, the lifestyle medicine movement, the longevity health movement, what you're starting to see is like little seeds of revolution kind of starting to kind of come together where people are saying, we're not going to just take it anymore.
We don't like the way US healthcare works anymore. And look, there was a past generation of this. It was the Oak Streets, the One Medicals. It was like, we're going to make primary care more convenient. That was fine. But I think what people are saying is they don't even like what primary care is today because primary we're treating people like widgets and we're treating clinicians like widgets. And that all needs to change in.
Travis: A big and important way as we look toward 2026. If the industry can do one critical thing to meaningfully improve equity, what would that be?
Sachin: Everything starts with acknowledging the problem and the denialism. Like we are living in a world of denialism. When there are inconvenient truths, we walk away from them. We're fitting the facts to the narratives more and more, as opposed to trying to build narratives off of facts. That's the work.
Travis: Fascinating. Sachin, thank you. It's been an incredibly thoughtful conversation. Your candor on the industry challenges and the framing of the vision about what's possible with equity when you can embrace the design principle of equity instead of a PR talking point. I think the conversation highlights how much opportunity and responsibility there really is in front of us. I think that's also incredibly exciting. Sachin, it's been great having you. Thank you.
Sachin: Likewise. Thanks so much. Good to be with you, Travis.
Matthew: Thank you for listening to the Oliver Wyman Health Podcast. This podcast is brought to you by the global management consulting firm Oliver Wyman. For more insights on the business of transforming healthcare, visit our online publication, health.oliverwyman.com.
This transcript has been edited for clarity.
