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Becker’s Healthcare Podcast
Driving Innovation in Medicare Advantage with Dr. Joe Kimura of SCAN Health Plan
00:20:33
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- [00:00]
A
Hello, everyone. This is Jacob Emerson with the Becker's Payer Issues podcast. Thrilled today to be joined by Dr. Joe Kimura, who is the Chief Medical Officer at Scan. Dr. Kamara, thank you so much for taking the time to be with me on the podcast today.
- [00:15]
B
Absolutely. It's a pleasure to be here, Jacob. Thank you so much.
- [00:18]
A
Yeah, absolutely. And before we dive into everything we want to talk with you about, Joe, can you tell us a little bit more about yourself, your background in healthcare and what it is that you do today at scan?
- [00:29]
B
Sure, absolutely. My pleasure. So I serve as our chief Medical officer here at SCAN Health Plan, and in that function I oversee the development and implementation of SCAN's clinical strategy across not just the health plan, but also its affiliated medical groups. And my purview is over the clinical quality, utilization management, the population health care case management, pharmacy, and the clinical innovation functions. And so for me, I'm a primary care physician through and through, trained in primary care internal medicine, did my fellowship training in health services research, and have focused my career really on the design and improvement of care, particularly in the outpatient ambulatory care system space. For the past two decades, worked both as a clinician and executive, really in value based provider organizations. Most of my time was spent in Eastern Massachusetts at Atrius Health and Harvard Vanguard, which was the provider side of the old Harvard community health plan. And I served as chief Medical officer there from 16 to 22. And prior to joining Scan, I actually spent three years within a specialty VBC startup serving as chief medical officer for Somatis, which was a value based specialty care provider in McLean, really trying to help patients with chronic kidney and cardiovascular disease to avoid those downstream complications. So kind of through the circuit, mostly on the provider side and, and we're really excited to be in this space here with a health plan, thinking about progressive ways to really help our members and patients stay healthy.
- [02:07]
A
Fantastic. Well, we're really glad to have you here with us to get your take on Medicare Advantage specifically and where you think that program is going to evolve and keep going. So let's talk a little bit about that. Obviously, ma, it's a very dynamic program. It's constantly changing. There's lots of headlines all the time about the state of the market, and we continue to see SCAN scale. There are lots of expansion into new markets. So from your perspective, Joe, what are some of the factors that you see driving future growth in the MA space and how is SCAN position positioning itself to address challenges and opportunities in. In what we know, like I said, is a Very evolving and dynamic market.
- [02:54]
B
It's a great question, Jacob, thanks. So I think in the Medicare Advantage space in particular, there is the fact that healthcare for seniors and older Americans really does get more complex, gets more complicated and our delivery system continues to be fragmented. Although I know coming from the provider side there's lots of efforts to try to streamline and make things more efficient and coordinated. But the reality is that we're still in a space where it becomes more and more challenging the more complex your health becomes. And where I think MA truly does deliver better value than the sort of the traditional fee for service Medicare chassis. Traditional Medicare often exposes seniors, I would say, to sort of higher out of pocket costs. And some of the things that we know are equally as important to sort of the traditional clinical care like vision, hearing and dental are all elements of day to day health care for seniors that are, if wrapped together and coordinated, actually provide better outcomes for everyone. MA does allow that kind of innovation by offering that coordinated integrated care and pushing all of us to be focusing on not just what we're doing, but what are the outcomes of what we're doing, how does those outcomes get better? And here at scan, I'd say that we're really trying to leverage, leverage that flexibility to try to get the right benefits, the right clinical care, the right coordination put in place to be sure that we're meeting seniors where there are, as well as trying to simplify the overall healthcare experience for our members as well as for our provider partners. And you alluded to the fact that sort of there are some challenges right in the landscape ahead. And as we look around, there are a lot of folks that are hesitating around Medicare Advantage and sometimes backing off a little bit. But for us, as a non for profit healthcare plan, we do believe that we have an opportunity, right, to really showcase what we can do when we have this kind of coordinated care and coverage benefit ability, that we can invest more in that better care, invest in more stable and comprehensive benefits and invest in being sure that we are there to provide that long term value for our members. And we could do it because of the ability that as a non for profit, we're thinking about the long game. We're not there necessarily for short term profits. And it has allowed us at SCAN to really do a lot of innovative things. For example, you know, we've, we've been sort of at the forefront of launching first of their kind plans around personalized care for women. Inspired our inspired plan for women or a firm plan for the LGBTQ Seniors and the allied plan for our Asian senior population. Again, that creativity and the flexibility that MA provides, coupled with our commitment and our mission as a nonprofit, really allows us to be bullish about the fact that we can continue to serve more and more members across this country to be able to provide that kind of care where it's needed, whether it's in the home, in the community, or even virtually. So super excited about the opportunity and really pushing forward and trying to make sure that we can continue to drive improvements in health outcomes for seniors.
- [06:35]
A
Absolutely. And to your initial point, Joe, I mean we've seen study after study and certainly on the ground experience like yours show that ma, it offers lower out of pocket costs, better benefits, better outcomes across many different spaces for seniors. So your point is well heard. But I want to follow up on something you mentioned. In terms of SCAN really does stand out among the in the MA industry in terms of very specific and personalized plans for, for certain populations, Asian Americans, lgbtq, older adults. So, you know, so much of your career has been based in innovation and value based care. So as you lead scan's efforts in this space, how do you envision the role of technology data analytics in shaping that more personalized and effective care delivery for your now more than 300,000 members?
- [07:29]
B
Yeah, it's a great question, Jacob, and sort of the side that perhaps I missed in my intro bio is that I'm actually boarded in internal medicine, but also boarded in clinical informatics. So technology and data analytics are a core part of why I think healthcare is heading forward and in this 21st century. Realizing we're 20 years into it now, but we're really in a spot where there's some exciting new capabilities addressing some of the challenges of how do we actually make sure that not only the reliability of getting evidence based care is happening more consistently across our population, but to your point around, how do you then personalize that care so it doesn't feel like we're doing cookbook or recipe based medicine on everybody? Because every, every member, every person has unique challenges, a unique set of circumstances that they're dealing with, even if they're, they're sort of all working and trying to optimize the care for common disease or common conditions. So I think technology and analytics are really critical enablers of this kind of personalized coordinated experience. And we're a strong believer at SCAN that the technological abilities that we bring forth are going to be foundational for being able to provide that kind of care going forward. And again, there's a lot of hype, Jacob. And, you know, and I think having heard prior podcasts as well too, I think everyone recognizes, you know, artificial intelligence, all the advanced analytics capabilities, there's a lot of flash that is happening within our industry. And it's really, really important to make sure that, you know, we're not chasing sort of that Gartner sort of early part of the hype cycle. But we're really trying to target using the right technology at the right time to match the care and support with the members and patients that really need it. And there's an eye towards trying to use that technology to simplify, to expediate the care and try to make sort of care more effective for our members, but also our provider partners, for our workforce. And everyone sort of involved wrapping around the care for those patients. And technology does enable that. Right. So our capability of using data, using the ability to sort of say, you know, you have one cohort of patients, say they have congestive heart failure, dementia or even diabetes, but within that seemingly homogeneous group, you have a lot of different sort of elements, or that data analytics can help surface and make it more efficient and more effective in terms of how care teams, including those on our side at scan, but also collaborating with our network provider partners, can really wrap around the services where and when it's needed, whether it's in the home, on the street, in the clinic, or even virtually. And that kind of capability was hard to do, right? Definitely hard to do 25 years ago when we were all on paper charts. But it makes it a lot easier today when you've got these kinds of ability to interchange and exchange that data and information across the network of providers. I would say that the virtual capabilities that we're seeing post Covid continues to make sort of, if I could say, sort of open up opportunities to try to really improve access and care for patients and members who are in sort of isolated areas that perhaps aren't being served as well by the providers in the community. Or honestly, the providers are overwhelmed. Right. We're seeing that a fair amount in terms of access issues across the board. And when we think about that virtual type care, though, we do need to keep in mind that we need to make sure that that system works with our older adults in mind. So we at SCAN have also invested in parallel to really push digital literacy, digital support, to make sure the tools are as accessible and easy to use. The last part of your question, Jacob, I think, was around data analytics. And this is sort of an area that's dear to my heart around population health. And the idea of enabling proactive world class care is something that I've always been super, super passionate about. And as a primary care clinician, it feels like that's our raison d' etre to really be at that place where I can help our patients and members prevent that hospitalization, prevent that rapid disease progression, prevent sort of the aspects of mental health challenges from isolation. Because if I can detect it sooner and know who is at risk, it gives me a chance to intervene probably with a sort of more efficient type intervention, but also a more humane intervention. Because when those complications happen, we all know we see it all the time. It is wonderful to provide world class care, but at that time you're kind of really behind the eight ball and you're chasing the try to rectify situation instead of truly preventing it. And I think there's no one in the world that would argue that if we could just, you know, hold true to our adage of an ounce of prevention is worth more than a pound of a cure, it really does make this place a lot better for all of us in terms of reducing suffering. And I think data analytics become and form the foundation of, of enabling us to be able to do that much more efficiently and effectively.
- [13:19]
A
Certainly, certainly. And you know, speaking of proactive care, let me, let me spout off a stat to you that I know you're familiar with and certainly I would imagine most of our audience is familiar with that. Around 10,000Americans a day are aging into Medicare. We expect that that number to keep growing. In terms of the overall ratio, there's. So how do you, how does scan, how are you thinking about that? How are you preparing for that, navigating what's already here? And from your perspective, given what we were just talking about, Joe, in terms of population health and data analytics, how do you continue to view where the healthcare landscape is going to change over the next three to five years when it comes to meeting this demand for senior care?
- [14:05]
B
Yeah, it's a great question, Jacob, and something that definitely we think a lot about. And you know, the, the, the demand side there with the 10,000 patients sort of entering into Medicare is coupled with the similar stat that I know that you're also familiar with where, you know, we have a lot of our workforce stepping away early retirements folks, sort of stepping away from direct care provider capabilities. And so we're facing a little bit of a storm, right, going forward to say, increasing need, decreasing capacity to care for the need. But also I'd add that third bit which says medical science is advancing. So guess what? We have more effective treatments available today to really change the trajectory of some of these clinical conditions that again in the past used to be much more difficult to manage effectively. And I think chronic kidney disease is one great example of that with the new medications that are now available. And I do think that this is where we do need to partner very strongly with our provider partners and try to figure out how do we bring the strength of a health plan with the strength of the provider groups to really try to thread this needle of making sure that the members that really have the needs that are paramount overall, not just from an experience perspective, but clearly from a health outcomes perspective, get the types of care that they need, despite the fact that access is challenging everywhere that we look. And so we've announced a couple of partnerships with large groups like Astrana and Sutter Health here in California, where we're really trying to figure out how do we work together to try to address those kinds of demand and capacity challenges. But on top of that though, I mean, as a primary career clinician, I would say there's another aspect here that's really important for us and for it's really pushing our ability to be able to help and coach our members to be able to be as effective as possible as they're navigating through. And you know, we think about our care coaching programs for our scan inspired members offers a lot of personalized one on one coaching to tackle many of the primary concerns of our members. And again, these kinds of programs, when you have activated, engaged and educated members, it enables sort of that member to become an active role of the care team and therefore also become more effective agents of their health care. And again, I think as we're looking at health plan and providers as two different arms, I do think our members provide yet a third arm, right of us being able to work together together to try to address some of the challenges that we're facing. And it is really, really a challenge that again, technology, you know, referencing our prior conversation also begins to help us with because in the past I would say that information was more sequestered, I would say in the care delivery space overall, but with the information, with the kind of tools that are available to the general public, healthcare information is democratizing and that is enabling our members and our patients to be much more informed around what they should be getting, when they should be getting it, how they should be getting it and how they prefer. We want to empower our patients and our members to really be that Kind of strong agent and advocate for their care. I think all of it becomes important to address the challenges that you mentioned.
- [17:57]
A
Absolutely. Well, exciting things ahead in the senior care space, and it'll be fascinating to watch SCAN continue to innovate there. Before we go, Joe, what else are we missing? You got a lot of health plan leaders and MA leadership listening in from. From all over the country. What do you want to share with them? Any. Any final bits of advice you'd offer?
- [18:18]
B
Yeah, no. Thank you for that opportunity and thank you again. Right. For this chance to actually speak with you and to. To share my two cents here. I guess I had two comments. One is that again, acknowledging where we are today with the complexity and the fragmentation that just exists in health care, really to try to be as straightforward as possible in terms of keeping that member experience at the center of everything. We try to push greater performance in terms of clinical outcomes or other kinds of KPIs and metrics, and that can sometimes drive more complexity. And we like to say that complexity isn't the sign of sophistication. It's more signal that perhaps we've lost sight of what we're trying to do and who we're trying to serve. So, first point would be, again, to really, really keep laser focused on that member experience. And the second point, probably the corollary to that, Jacob, is that we do believe that the next revolution in terms of digitalization of healthcare really comes with the interoperability coming into its own. And I think as we're seeing the new sort of capabilities really start to open up a more freer flow of data and information across health plans, providers and patients. There is a tremendous opportunity here to reduce that friction, eliminate the waste, and make room for real collaboration. So the second piece would be to keep an eye on that interoperability coming and be ready to be able to jump in and be more effective partners in connecting our care across all the different domains. Because I think it's going to be an exciting window coming forth.
- [20:10]
A
Wonderful. Well, Dr. Kimura, thank you so much for taking the time to sit down with us and for sharing your insights with our audience. We really appreciate it.
- [20:19]
B
Absolutely. Jacob, it was a privilege. And thank you so much.
- [20:22]
A
Yep. To our listeners. If you'd like to listen to more podcasts from Becker's Healthcare, you can visit Beckershospitalreview.com.