FEATURE · POPULATION HEALTH MANAGEMENT
Q&A: Sachin Jain, M.D., M.B.A., on Ending Annual Insurance Enrollment
By David Raths I
n a recent Forbes article, Sachin Jain, M.D., M.B.A., CEO of California-based SCAN Group and SCAN Health Plan,
suggested that ending annual enrollment in health insurance would actually con- tribute to curing a lot of what ails the U.S. healthcare system. In an interview with Healthcare Innovation, Jain discussed the logic behind his proposal.
HCI: The headline of your Forbes article is: ‘Want Real Value-Based Care? End Annual Enrollment in Health Insurance.’ Can you explain why getting away from annual enrollment would help payers improve their focus on things that matter? Jain: I first heard this idea in conversations with Sukanya Soderland, M.B.A., chief strat- egy officer at Massachusetts Blue Cross Blue Shield. For one, think about the healthcare innovation ecosystem and the challenges that many of the leading vendors face in getting contracts, which is that they've got to show actuarial returns within 12 months. But a lot of things that are going to improve long-term health outcomes have nothing to do with 12 months. If I invest in efforts to reduce your weight by 50 pounds this year, and I avoid the cost of heart attack and diabetes five years later, I'm not necessarily incentivized to do that, because you may not be my member in five years. Even though we have a growing
number of evidence-based interventions to improve healthcare outcomes over a five-year period, there's lower than ideal adoption. This is really a market ineffi- ciency that's been created by how we've done policy in our country. We've created this regulatory and statutory mandate that people would have one-year plans. Now as I floated this idea in Forbes, on LinkedIn and elsewhere, people responded that con- sumers really want to choose. But I say that there are probably some consumers who say, ‘Hey, if you're invested in my health over a three-year period, and you gave me an enhanced benefit package that is more oriented around long-term invest- ments in health, then I would choose to be locked in for five years or three years or seven years. I actually think the ultimate
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answer is that we need some regulatory relief from CMS. And then we need to be able to offer consumers the opportunity to opt into a plan that has a three- or five-year benefit cycle.
HCI: In the Forbes article, one of the bullet points about the benefits of your proposal is that health plans would stop offering shiny benefits that don't improve health. Why Is that happening now and why would it stop? Jain: Well, look, the most competitive period in the healthcare industry is our annual enrollment period for Medicare Advantage October 15 to December 7 every year. We have seven weeks to try to get your attention and have you become a member. And, brokers and people who sell insurance are both aligned to try to find people the right plan, but they are also trying to sell as many people as they can in that period because they're paid based on commissions. Really smart sales reps and brokers focus on how quickly can I get your attention and give you something that you need and want and then move on to the next customer. The fastest way to close sales with people is to align a benefit with something that they need. If they've been holding off on $3,000 of dental work, they're going to choose the plan that gives them the $3,000 dental benefit. If they are strapped for cash, they may choose the plan that has the Part B rebate. But in many ways these shiny benefits have distracted us from the
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original intent of this plan, which was to optimize people's Medicare. I think there's a broader argument
that extends beyond this article, which is that we need to take a hard look at our Medicare program. This is a program that was originally invented to reimburse bills. It wasn't invented to actually keep people healthy. If you look at part A and Part B Medicare, it was originally intended to pay your hospital bills and your doctor's bills. It did not have a clinical perspective. If you were invent- ing CMS from first principles today, you'd probably hire 100 geriatricians to think about this. If the interventions were to keep people healthy and keep people independent, they would look very different from the benefits that we have today, which are primarily around payment and reimbursement.
HCI: Well, isn't that kind of what Medicare Advantage is supposed to be about — better coordinating people's care? Jain: It is and it isn't. The truth is that we've failed on some level. The way I know that we've failed is that we've been engaged in the zero-sum debates about whether Medicare Advantage is better or fee-for-service Medicare is better. I would say if our industry had done its job, we would have settled those debates a decade ago. When we used to talk about the move to value, we talked about your feet being in multiple canoes moving in different directions. Now we've got 10
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