Zack Myers, National General Manager at SCAN Health Plan

Summary

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Episode Overview

Podcast: Becker’s Healthcare Podcast
Host: Jacob Emerson (Becker's Healthcare)
Guest: Zack Myers, National General Manager, SCAN Health Plan
Date: September 20, 2025
Theme: SCAN Health Plan’s growth, evolving Medicare Advantage landscape, value-oriented partnerships, and innovative care for seniors.

Zack Myers shares his journey through healthcare and highlights SCAN Health Plan's mission-driven approach to Medicare Advantage growth, emphasizing member experience, provider collaboration, and disruption of negative industry trends. He also discusses the organization’s leading position in Institutional Special Needs Plans (ISNP), predictions for the future of Medicare Advantage, and meaningful partnerships to advance value-based care.

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Guest Introduction & Background (00:14–01:47)

• Zack Myers describes his career, starting in healthcare technology with a family business, then moving through care management roles, and finally joining SCAN Health Plan.
• Quote:

  "I'm responsible for the performance and operations of our markets across the country. We're a growing health plan, now in five states, soon to be six, with over 300,000 lives that we are responsible for the care of."
  (B, 00:25)

• Early career focused on tech for assessing and improving primary care and value-based care payment.
• Leadership roles in Southern California senior care, showing a long-term commitment to improving senior health outcomes.

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Medicare Advantage Growth Drivers & Industry Challenges (01:47–05:45)

• Medicare Advantage (MA) Appeal:

  • "Seniors have really voted for the MA program with their feet. Now we now have more than half of all seniors in the Medicare Advantage program, in large part because they've seen the real value proposition..."
    (B, 02:30)
  • Core drivers: Additional benefits, comprehensive coverage, support for seniors on fixed incomes.

• Industry Headwinds:

  • Margin compression, payment changes (e.g., V28), declining STARS ratings.
  • Many plans withdrawing from markets, increasing claim denials, and prior authorization burdens—leading to a "vicious cycle" of worsening experience for members and providers.

• SCAN's Distinctive Approach:

  • Nonprofit status enables reinvestment in members and provider partnerships.
  • Focus on fair payment, reducing administrative friction (less claims denials/prior auth), and building a “virtuous cycle” (better provider satisfaction → improved member experience → higher STARS scores → reinvestment).
  • Evidence: Over a decade of 4+ STAR performance in California.
  • Quote:

    "Our vision is really to be the most preferred partner for providers and health systems across the country. And what that allows us to do is create a virtuous cycle..."
    (B, 03:20)

• Contrasting Industry Moves:

  • While other payers shrink, SCAN is expanding into their sixth state during the Annual Enrollment Period (AEP), aiming to maintain market-leading benefits (B, 05:45).

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Predictions: The Evolving Landscape of Medicare Advantage (06:07–08:10)

• Unpredictable Future:
  • The direction “at the whims of CMS."
• Continued Vital Role:
  • MA will remain crucial for seniors/government.
  • Plans must deliver meaningful, sustainable value rather than “gimmicks.”
• Necessity for Innovation:
  • Building strong, aligned provider partnerships to manage costs and keep seniors healthy/independent.
  • Emphasizes adapting to new technology (AI, therapies, testing).
  • Quote:

    "As a nonprofit, I think scan's pretty well positioned to lead across all of those different changes that I just talked about. And you know, we really want to demonstrate how mission-driven organizations can help set the standard for what Medicare becomes and looks like."
    (B, 07:49)

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Spotlight: Institutional Special Needs Plans (ISNPs) & Community Partnerships (08:10–11:36)

• ISNPs as Mission Embodiment:
  • SCAN's Embrace product: Largest, fastest growing ISNP in California.
  • Focuses on keeping seniors healthy/independent within their communities.
• Innovative Care Delivery:
  • Deploy rapid, 24/7 care directly to facilities.
  • Preventing unnecessary hospitalizations and managing chronic conditions proactively.
  • Emphasis on partnership with "community operators" to integrate healthcare in senior living communities.
• Key Partnership Example:
  • "We recently announced a partnership with Brookdale Senior Living where we're expanding across their 33 communities in California and Arizona..."
    (B, 10:49)
• Growth Outlook:
  • ISNPs expected to continue outpacing traditional MA growth, with replication of the Embrace model in other communities.
• Quote:

  "Our ISNP program, which we call Embrace, has really developed a better model delivering care directly into the community... to deliver higher level urgent care and even before it gets there, to prevent exacerbations of chronic illness before they ever happen."
  (B, 09:28)

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Final Thoughts: Advice to Health Plan Leaders (11:36–13:10)

• Call for Collaboration:
  • Traditional friction between plans and providers isn’t inevitable.
  • Advocates for “deep, long-term partnerships” to improve health outcomes and economics.
• Recent Example:
  • Partnership with Sutter to co-design health plans and benefits, centering both provider and patient wellbeing.
• Quote:

  "I personally believe that there's an opportunity to build the kinds of deep long-term partnerships with providers that ultimately result in better healthcare and better economics for everyone."
  (B, 12:07)

• Advice for Industry:
  • Challenge zero-sum thinking; work together to make the healthcare system stronger.

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Memorable Quotes & Moments

• “Seniors have really voted for the MA program with their feet.” (B, 02:30)
• "We have the opportunity to reinvest our margin back into our members and our provider partners." (B, 03:00)
• "Our Embrace product is the largest and fastest growing ISNP in California." (B, 11:30)
• "You see a provider is less happy. You see plans pulling back on benefits. The result is those plans of worsening member experience, worsening STAR scores, and ultimately... the circle kind of continues." (B, 03:02)

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Key Timestamps

• 00:14 — Myers’ background and SCAN’s growth
• 02:30 — Medicare Advantage’s consumer appeal and industry headwinds
• 03:20 — SCAN’s mission-driven, partnership-focused approach
• 06:32 — Future trends and predictions for Medicare Advantage
• 08:56 — ISNPs, SCAN Embrace, and partnership with senior living communities
• 11:36 — Growth metrics for ISNP/Embrace program
• 12:00 — Advice to health plan leaders: collaboration and innovation

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Summary Takeaways

• SCAN Health Plan is expanding despite industry contraction, leveraging a nonprofit, member-centered approach.
• Prioritizing deep provider partnerships improves member outcomes and organizational sustainability—a contrast to national trends of increased administrative friction.
• ISNPs, especially through the Embrace program, are a strategic focus for delivering integrated, community-oriented care to the most vulnerable seniors.
• The future of Medicare Advantage will depend on mission-driven organizations, technology-enabled care, and true collaboration between payers and providers.

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Transcript

[A]

Hello, everyone. This is Jacob Emerson with the Becker's Payer Issues podcast. Thrilled today to be joined by Zach Meyers, who is the national general manager at Scan Health Plan. Zach, thanks so much for taking the time to be with me on the podcast today.

[B]

Yeah, thank you.

[A]

So, before we dive into everything, we want to talk with you about Zach and all the latest going on at scan. Can you tell us a little bit more about yourself, your background in healthcare and what it is that you do at the company?

[B]

Yeah, sure. Well, as you shared, I'm scan's national general manager. I'm responsible for the performance and operations of our markets across the country. And. And we're a growing health plan. We're now in five states, soon to be six across the country with over 300,000 lives that we are responsible for the care of. You know, I started my career in health care technology. I kind of grew up in it, Jacob. I. My family owned a company back in the day called CEC City. Terribly named business. We could have used scan's marketing team, but we built interesting technology in the early days of healthcare tech that helped primary care physicians measure the way they delivered care and the quality of care they were delivering, and then helped them to get paid under the earliest pay for performance programs that CMS put out. I helped lead the sale of that business to Premier in 2014 and then spent really the next decade of my career in the world of Southern California senior care, really devoted to the mission of how to improve the quality of life for seniors. First, first at a company called CareMore Health, where I ran their largest P and L for a number of years, and then here at scan. So excited to chat with you about all things payers, providers and how to improve care for seniors.

[A]

Yeah, absolutely. So you've been in the industry for a long time, Zach. It sounds like it's personal for you as well. You've seen a lot of different trends and different direct the industry has gone over over the last decade or so. So you mentioned Skin is going to be expanding into its sixth state. The company continues to expand into new markets. Talk to us about some of the factors that you see driving future growth for Medicare Advantage right now. There's obviously so many headlines, so many changes we've been hearing about over the last few years within the program. So where do you see SCAN positioning itself to address some of the challenges and the opportunities in what. What, as you know, is a very evolving market?

[B]

Yeah, yeah. Well, you know, despite all the various headlines we've seen in the industry, I think the reality is that seniors have really voted for the MA program with their feet. Now we now have more than half of all seniors in the Medicare Advantage program, in large part because they've seen the real value proposition right around having access to additional benefits, comprehensive coverage in particular for those seniors living on fixed incomes who really depend on stable, affordable access to care. That's not possible under a Medigap policy or Medicare fee for service alone. You know, I think even in the face of that growth, what we've seen is some real headwinds in the industry. Margin compression, changes to the payment model, in part because of V28 and a general decline in national STARS ratings across many plans. You know, most health plans have reacted to that by pulling out of the markets. I think we're going to see hundreds of thousands of seniors lose access to their health plan this AEP or really squeezing their provider partners. You know, we've seen real growth in claim denials, increasing use of burdensome prior authorization, and the result is really a vicious cycle, right? You see a provider is less happy. You see plans pulling back on benefits. The result is those plans of worsening member experience, worsening STAR scores, and ultimately, you know, the circle kind of continues. And I think where scan, as a nonprofit health plan who's been in this industry for decades, we're positioned to take a different approach. We have the opportunity to reinvest our margin back into our members and our provider partners. And our vision is really to be the most preferred partner for providers and health systems across the country. And what that allows us to do is create a virtuous cycle instead of the sort of downward spiral I was just describing. So you see fair payment for providers not playing games with claim denials and prior auth, you know, creates better alignment with your groups. The result is a better member experience and improved STARS performance. You know, at scan, we've seen that we've had four plus star performance for over a decade in our core market in California and ultimately higher revenue that we can reinvert, reinvest in member experience and growth. And so we see a different way of approaching the market that will allow us to win in the face of all the change in the industry. Does that make sense?

[A]

It does make sense and it really aligns with everything that we consistently hear both from the hospital leaders and from the health plan leadership pretty much every day at this point, Zach, in terms of the squeezing of profit margins of providers, the turmoil that everyone is expecting, membership wise heading into aep. But I know, you know, speaking from with SCAN leadership over the years, it's really great to consistently hear how the company acknowledges these industry problems and then tackles them head on and wants to fix them.

[B]

I'll just mention, you know, we, the proof point for that from a SCAN perspective is we're now not really pulling out of any markets. We're expanding into the markets as aep. And so you're going to see us sort of with, with hopefully market leading benefits expanding into our sixth state, continue to grow in the states that we operate in. And so we're excited about that.

[A]

Yeah, no, it's really great to hear and it definitely is. In contrast to obviously a lot of other big players out there. I wonder, you know, I know there's a lot going into just this enrollment period, but if you were looking at the healthcare landscape terms of how it's been evolving and how it will evolve over the next three to five years or so, is there anything in particular that stands out when it comes to Medicare Advantage? Any predictions from on your part that you would want to share?

[B]

It's hard to predict where this goes. There's so many, you know, it's at the whims of CMS in many ways. But you know, I think we're, we're going to see Medicare Advantage continue to play an important role for seniors and for the government. I think it will evolve in pretty significant ways. I think plans are going to have to adapt to tighter margins, which is going to require being very thoughtful about how do you deliver meaningful value to seniors through the right benefits, not gimmicks, and then build the kind of provider partnerships that can actually bend the cost curve and keep patients independent and healthy, which is, you know, fundamentally our mission. And I think part of that's going to be the reality of changing technology, of course, AI, but also, you know, we're seeing real novel medications, therapies, testing modalities. And at scan, we're thinking very creatively about how do you build sort of the care models of the future that can wrap around and support our provider partners to improve quality of life and create savings. But I think that's going to be a really like narrow line to tiptoe here over the next few years. As a nonprofit, I think scan's pretty well positioned to lead across all of those different changes that I just talked about. And you know, we really want to demonstrate how mission driven organizations can help set the standard for what Medicare becomes and looks like.

[A]

Yeah, no, absolutely. I mean, and I appreciate your candidness around that topic as well. There, Zach and I, I wonder if we're, if we're sticking on the topic of caring for the most vulnerable. And certainly that applies to a big swath of the Medicare population. One area we've really seen a lot of growth, more than traditional Medicare Advantage in terms of growth over the last few years is within special needs plans. And so can you talk to us about institutional special needs plans specifically? Because that's another segment, like I mentioned, we've seen a lot of growth there, higher than normal. Ma, where do you think is the opportunity there in terms of continued expansion in that segment? Continuing to see some of the growth margins we've seen there. What, what happens there in the next few years?

[B]

Yeah, I'm, I, I'm really excited to talk about the ICE net world because we view ISNP as the real, maybe the best embodiment of scan's mission to keep seniors healthy and independent. You know, our, our Embrace product is now the largest and fastest growing ISNP in California. And it's delivering markedly better patient experience to the members who it serves right. Facilities instinct often is to call 911 at the first sign of any trouble for their patients because it's impossible for them to get the kind of rapid response they need to keep the folks living in their communities at home. Our ISNP program which we call Embrace, has really developed a better model delivering care directly into the community available 247 there to deliver higher level urgent care and even before it gets there to prevent exacerbations of chronic illness before they ever happen. Part of the reason we're seeing that level of growth is because there's been an increasing recognition from community operators that there's an important intersection between healthcare and the community, that keeping folks healthy and in their building is both right for the, for those members and also important for the economics of their operations. And so we, we think where ISNP will go in the next number of years is, is continued growth around real community operators who see, who see this vision and want to build the kind of transformational partnerships with SCAN that can, that can bring this to their community. So you know, for example, we recently announced a partnership with Brookdale Senior Living where we're expanding across their 33 communities in California and Arizona and partnering around how can we keep their communities healthy in our ISNP product. So we hope to replicate that model with many other operators in the years to come.

[A]

Understood. So you foresee continued growth in this segment. You're partnering and want to continue partnering with these senior living facilities. And what was that statistic you cited, Zach, about, isn't it at the beginning being one of or the fastest growing for you in California?

[B]

Embrace is the largest and fastest growing ISNP in California.

[A]

Fantastic. Well Zach, as we wind down on on time here, you've got the ears of a lot of other health plan leaders listening in from all over the country. Everyone's I think, feeling a little bit nervous, excited going into aep. So if you're speaking to them all directly, any final thoughts, final bits of advice as we, we enter this, this period of the year?

[B]

You know, I think historically plans and, and providers have often seen ourselves as in competition that, that, that these health plan industry is a bit of a zero sum game and we take a different approach and I personally believe that there's an opportunity to build the kinds of deep long term partnerships with providers that ultimately result in better health care and better economics for everyone. And that's the kind of partnerships that we're building now. We recently announced our partnership with Sutter to do just that and think about how can we co design health plans and benefits that improve the life of providers as well as patients and then get really deep into the way we deliver care to improve outcomes fundamentally for everyone. And so I would just say that there's an opportunity to do that for anyone who operates in this industry and to think about how we can make the system stronger as a whole by working together.

[A]

Wonderful. Well Zach, I really appreciate you taking the time to chat with us and for sharing your insights with our listeners. We really appreciate it.

[B]

Thank you. I enjoyed the conversation.

[A]

Yeah, likewise. And to our listeners, if you'd like to listen to more podcasts from Becker's, you can visit beckershospitalreview. Com.