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.

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.

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).

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)

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)

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.

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)

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

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.