RamaOnHealthcare January 25, 2021

RamaOnHealthcare and Sachin H. Jain, MD, MBA, FACP, President and CEO of SCAN Group and SCAN Health Plan, explore Medicare Advantage, geriatric care, and the other public option.

RamaOnHealthcare: President Biden has indicated he’s in favor of some kind of “public option” in order to expand healthcare to more people. Many people have called for “Medicare for All.” But you advocate for a different approach, “Medicare Advantage for All.” Why?

Sachin Jain: For more than twenty years, Medicare Advantage (MA) has relied on public-private partnerships to expand access to care, lower costs and improve health outcomes for millions of Americans. This is exactly what the country needs right now.

RamaOnHealthcare: What makes MA a better option than traditional Medicare?

Sachin Jain: Under the traditional Medicare structure, the government pays doctors and hospitals for individual services, tests and procedures. Medicare Advantage differs in that the government sends capitated payments to private insurers—including not-for-profits—who are charged with providing highly coordinated whole-patient care. MA plans are extremely popular among older adults in large part because they cover a variety of health-related benefits like gym memberships, acupuncture and chiropractic services. They also commonly charge no premiums, cover prescription drugs, and include low-cost vision and dental benefits.

RamaOnHealthcare: Earlier you mentioned improved health outcomes. How do Medicare Advantage plans improve outcomes for beneficiaries? 

Sachin Jain: Great question. A recent study looked at people with multiple chronic conditions and found that Advantage plans performed better on several key measures, including hospitalizations—which is extremely expensive—and higher rates of preventative screenings. Another factor is that the private insurers that administer Advantage plans have proven track records collaborating with public officials to design affordable plans that deliver what the consumer wants. All of these factors combined contribute to better health outcomes.

RamaOnHealthcare: I can see how these factors may make MA plans appealing to a broad spectrum of the population. However, the question on everyone’s mind is cost. What will this cost taxpayers?

Sachin Jain: A study showed that beneficiary costs for Advantage enrollees are about 40% lower than for those in traditional Medicare. As for how much it would cost taxpayers, the cost to care for Medicare Advantage enrollees is typically less than it is for traditional Medicare. However, it’s impossible to know exactly how much any “public option” might cost taxpayers without knowing the details of each proposal, such as: Will there be premiums? How much are co-payments? What types of benefits will be included? Nevertheless, past practice demonstrates that it costs less to care for Advantage enrollees.

RamaOnHealthcare: What are some of the challenges with Medicare Advantage plans?

Sachin Jain: In speaking about the cost savings, it’s essential to note that much of this savings derives from the value-based payment contracts baked into most Advantage plans. And that could present a challenge, because Americans often say they want to see any doctor in any network of their choosing. That vision is incompatible with most Advantage plans, which derive their savings —as well as the cohesion of care they provide—from managed-care networks which, by definition, limit one’s choice of providers. But, on the flip side, growing Medicare Advantage would not require a massive expansion of the federal government’s role in healthcare—something Americans have repeatedly said they don’t want—and which an expansion of traditional Medicare would require.

RamaOnHealthcare: On a related subject, you recently announced that SCAN would be launching an initiative to provide home-based and virtual primary care to older adults. What is this project?

Sachin Jain: When we looked at the status quo in healthcare, we discovered large gaps with regard to care for older adults. Most older adults see primary care physicians, just as they’ve always done. And if you know an older adult, then you know this approach results in care that is reactive and inconvenient, and which often leads to inappropriate treatments and poor outcomes. That’s because primary care wasn’t designed for older adults. Geriatric care was.

RamaOnHealthcare: How so?

Sachin Jain: Geriatric care takes into account two things. First, treating older adults requires a different body of medical knowledge. Dementia, falls, pressure ulcers—these are all conditions you rarely see among people in other age groups. Second, geriatrics uses a different philosophy of care. The goal of geriatrics is not necessarily to cure people. Instead, good geriatricians work with other clinicians and providers to balance treatment for disease with patient quality of life and function, and weigh the pros and cons of intervention. 

RamaOnHealthcare: Your initiative is designed to work through the Medicare Advantage payer model. Why?

Sachin Jain: Because the business model behind Medicare Advantage wholly aligns with the philosophy behind geriatric care. It rewards providers and insurers who align their care with the goals of their patients—and not with the financial needs of hospitals and other high-cost providers. 

Topics: ACA (Affordable Care Act), Govt Agencies, Healthcare System, Insurance, Interview / Q&A, Medicare, Medicare Advantage, Patient / Consumer, Provider, Trends
Association Between Adherence, Social Predictors Among Medicare Advantage Enrollees
Payer, Provider Launch Wellness-Focused Medicare Advantage Plan
What Medicare Advantage Plans Want From Home-Based Care Providers
Hospices See Rising Volume, Billing Challenges in Medicare Advantage
Devoted Health, onehome partner on home health for Medicare Advantage members