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      Understanding Generation 2.0 Health Equity with Scan Health Plan

      Healthcare Rethink - Episode 24

      Join industry leaders from Scan Health Plan, Dr. Romilla Batra, Chief Medical Officer, and Sharon Jhawar, Chief Pharmacy Officer, as they discuss how they are making health equity a strategic priority in their organization and the role data plays in addressing health disparities.

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      Healthcare Rethink: Hear From Leading Changemakers

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      Brian Urban (00:22):

      Yes, this is the Healthcare Rethink podcast. I am your host, Brian Urban, and today we have a big one. We brought in from SCAN Health, the Chief medical Officer, Romilla Batra, and Chief Pharmacy Officer, Sharon Jhawar. Welcome to our little show.

      Sharon Jhawar (00:41):

      It's a pleasure to be here, Brian.

      Romilla Batra (00:42):

      Thanks for having us.

      Brian Urban (00:44):

      Well, with every episode, we like to have our guests get to know our audience and vice versa, and what way to better do that than introduce who you are and how you came to be in your leadership roles at SCAN? Let's start with the Chief Medical Officer. Romilla, how did you get to your role and how does it mesh so well with your background and the work that you do at SCAN today?

      Romilla Batra (01:09):

      Yeah, I'm a primary care physician and internist by background. I've spent first 10 years of my life working in academic medical centers like UCLA, UCI, Indiana University. And got to do a lot of teaching, also got to do a lot of clinical care. And as I pivoted after 10 years to SCAN Health Plan, I've been with SCAN Health Plan for 12 years.

      (01:33):

      What drew me to SCAN Health Plan was a mission driven, not-for-profit status, and also the fact that as a physician leader at SCAN, instead of having a panel size of 800 or 1,000 patients that I had as a practicing physician, I had a panel size of 300,000 older adults, which is what we have at SCAN. And so that was very compelling for me as I joined SCAN and in the 12 years that I have been with SCAN, I got the opportunity to grow and I got the opportunity to grow with SCAN, as well as do different things that supported our mission and supported the older adults that we serve.

      Brian Urban (02:10):

      Thank you, Romilla. I can just tell that what a difference in evolution you've probably even had in your 12 years at SCAN that's now followed your primary care practicing days. Sharon, let's talk a little bit about you. How did you get into Chief Pharmacy officer at a health plan? Bring us through the story.

      Sharon Jhawar (02:33):

      Yeah, my background is a geriatric pharmacist and I did my training at the VA. And believe it or not, I was SCAN's first full-time pharmacist 20 years ago, and so been with SCAN for 20 years. As I've been focused on older adult care, one of the biggest things that I've realized over the past 20 years is that there's a lot of things we all go through in life, but one of the most difficult ones is aging. And feel really good to be a part of SCAN Health Plan and helping seniors stay healthy and independent. On the medication side, a lot of that has to do with affordability, understanding your medications and taking them.

      Brian Urban (03:13):

      Wow, what a patriarch you are of SCAN Health, both of you, not only with the length of time you've been there, but the first leading pharmacist at SCAN, how cool is that?

      Sharon Jhawar (03:27):

      Super cool.

      Brian Urban (03:30):

      All the lives you've touched.

      Sharon Jhawar (03:31):

      And a lot of changes. Seen a lot of changes and regulatory changes, too.

      Brian Urban (03:37):

      Regulatory changes as well, and I'm sure they're not going to stop either. We'll definitely get into that. It's so interesting to have you both because you have obviously, deep experience and expertise and you've seen SCAN grow beyond Southern California, in some multiple states. And not only that, but Sachin has really pulled together a unique culture. Not only that it's authentic and it's caring, but you're still very core to your mission, which is helping older adults achieve better access to care and better coordinated care overall.

      (04:11):

      Of course, I'm paraphrasing here, but it's amazing and I wanted to first kick things off with your health equity initiatives. You touch a lot of high need populations that have really unique needs that's very different from commercial and even that of Medicaid as well, being Medicare Advantage. Can you walk us through some of your biggest health equity aims or projects that you're deploying in 2023 and even perhaps beyond?

      Romilla Batra (04:43):

      Maybe I'll kick it off. I think for us, health equity starts as not something that you do by the side of your desk, it starts with us having it as a strategic focus. And so for organizations, as they're thinking about health equity, it's not a fancy initiative that you're doing a project or a pilot, it is our strategic focus. And so as we thought about health equity, we thought in the realm of how do we A, have diverse populations but make sure they have the best outcomes? How do we have the right physician and medical groups to serve those diverse populations and how do we have the right community partners that are also working hand in hand with us? And so when we look at our health equity goal, is to align all those things together.

      (05:27):

      How do we focus on certain areas which are key areas around inequities or disparities, and we have found a few of them? And then how do we not only make it, "Oh, do we have to do it alone," but our whole ecosystem does it together? How do we bring our community providers along the way? How do we bring our employees along the way? How do we align incentives across the board. And then how do we have the right data to make it happen? I'll give a few things and then Sharon does this all day, she can give a better account of details that we do it in. Data is a big deal for us. A lot of people right now in different organizations are talking about collecting data, having data, and I would say we are fortunate because we've been getting race and language data for the last few years and we have data on 90% of our population, which is very powerful.

      (06:14):

      That being said, I'm sure there are many skeptics out there that'll come back and say, "Hey, it's not complete. What makes you think it's completely there?" And so our mantra for it is, "Let's do progress over perfection and let's start somewhere. Let's change and do something versus just watching and waiting for the data to get perfect." Those would be the four big pillars, I would say when we think about equity, those are the four pillars we have focused on.

      Sharon Jhawar (06:38):

      Yeah. And so our journey, Brian, really began several years ago, back in 2021, we took a look at health outcomes of our members, and being a Medicare Advantage plan star ratings program, there's about 40 different areas that the Medicare system ranks us in terms of providing quality care. And we took a look, like Romilla said, by race, how we were performing in those outcomes measures. And we have been a four and a half star plan six years in a row, but when we looked at how we were performing by race, we were not a four and a half star plan for our Hispanic members, our black members. It was pretty eyeopening to the organization and a big blow and all of us saying that this isn't right, care is not equal and how do we begin to make a difference? And so it was really an eye chart when we were looking at all the disparities that we saw.

      (07:36):

      And we don't want to boil the ocean and get nowhere, so we thought to ourselves, we saw some disparities on the medication side and we said, "We know good things come when you take your medications for diabetes, blood pressure and cholesterol. Let's start here, let's learn what makes a difference in these communities and then we can begin to tackle some of the other disparities that we see as well." And so really, our efforts in 2021 were around understanding our members, what challenges they were facing and how the healthcare system and our provider partners needed to adjust in order to provide better care to our Hispanic and black members.

      (08:21):

      And so I can just share a little bit about some of the big key learnings that we found throughout the process. We began with ethnographic interviews with our members, our black and Hispanic members, in addition to talking to all of our employees here that were black and Hispanic to say, "Hey, what do we think the challenges are related to taking your medications?" And some key themes that really emerged where the healthcare system was not helping our members enough were around, "I can't take care of myself if I don't understand my healthcare provider and they're not speaking my language." So language was a key thing, especially for our Hispanic members. If you're not speaking in language, they're not understanding what their condition is, why they should take their medications, and that leads to a lot of non-adherence.

      (09:18):

      There was another piece around understanding the importance of taking medications as another key piece. And so through these efforts of identifying what were the key areas we needed to improve on, we started to kind of fill those gaps. One of the key things that, at SCAN we've been doing, is proactively, culturally pairing our advocates and our pharmacists with our members that are having challenges with medications. You don't have to request it, we are proactively doing it. And we also did it with our black members as well.

      (09:55):

      And it was very interesting at the very beginning when we were going to culturally pair like this, the team here was like, "Sharon, can we do this? This feels awkward." For language, everyone felt comfortable. If someone spoke Spanish, yes, our member speaks Spanish, but is it right to ask our black employees to speak to our black members and profile and pair that way? And we just had to have open conversations and we asked our team, "Would you be comfortable if we paired that way?" And everyone was on board, but it was a pause moment where we were asking ourselves, "Is this okay to do?" Some people felt uncomfortable.

      Brian Urban (10:40):

      And that's really important that you bring that up, Sharon, is it's a cultural shift internally and externally. There has to be a unifying agreement that we need to be able to openly address the needs that we have and preferences that we have. And Romilla, I love that you're open about collecting the race, ethnicity, preferred language and saying at a very high confidence, about 90% of your member population you know. And everyone will, I think from a sourcing perspective at the industry level, say that's a very challenging thing to get accurate, is race, ethnicity, preferred language. But when you're talking about a member population that's been with you for a while, has good engagement, they're going to self-report at a higher accuracy level than if you were just doing the data pooling or sourcing outside of your walls. I think that speaks a lot to the trust that you've built along your members' journey and the engagement as well.

      (11:42):

      I absolutely love that and I want to go up one notch, and take me down if you need to here, but I'm curious, Romilla, from a medical loss ratio, medical cost ratio perspective, there's a lot of health plans out there that don't share your same true mission-driven work in health equity. Maybe they're doing it still as a PR player or marketing play, but you all have proved out the investment into health equity and interventions. Have you seen this hit a positive way in your bottom line? Have you seen the return not only from health outcomes or from experience improvements? Of course, quality bonus payments is a part of the MA world with caps. Have you seen some of that business case that I think a lot of other health plans are lost on or are hesitant to really pull the trigger and truly invest?

      Romilla Batra (12:40):

      Yeah, first and foremost, we think about it not as a medical loss ratio, we think about it as medical benefit ratio. We want to think of it as a benefit for our members that we are providing. When you look at all these things, both you and me know that the classic ROI doesn't happen over a period of six months or eight months or nine months, it's a much longer runway. And so the way we broach it is two things. It's value on investment, so are we truly moving the needle on some value metrics? And for us, the quality metrics at five star sets are good ones, because not only can we compare ourselves to ourselves, we can compare ourselves to our peers. Plus to your point, the star rating also has some reimbursement tied to it. Those are the value on investment we measure.

      (13:28):

      And honestly, we also measure on something I heard recently and love it, is return on humanity. At the end of the day, if we are going to serve members, we are based out of California, Arizona, Nevada, we have 21,000 dual members. We have a big chunk of our population that is Hispanic. We have 8% to 9% people are African-American. We also have others who are in the LGBTQ+. We in fact, introduced a new product, Affirm, that attracts and has benefits for LGBTQ+ population. We see ourselves in a space where we should be doing more of this versus looking at our MLRs and costs and stuff. The business, we truly believe also is the right thing to do also, is the business excellent thing to do. So yes, in a course of next two to three years, we can look at, did it improve things like admissions? Did it improve things like ER visits? Did it make people more loyal to staying with us?

      (14:22):

      Because guess what, when my community health workers or our pharmacists are calling, it's building trust, it's building that relationship. Do our people stay longer with us? Which, in our industry circles, you can see there's obviously a ROI attached to that. We also want to know what their outcomes are going to be. If they're going to be with us, they're going to be more healthy and independent. Not only have you lifted them, we have also solved for other problems or utilization problems that may come alongside it. So for us, it's a longer term view and if you look at what we are doing in the health equity space, we are doing a multi-year journey. To Sharon's point, 2021 was all about the era of adherence, but this year we decided we are not going to make it a flavor of the year.

      (15:04):

      We are going to pick two or three hard to move metrics in our Hispanic and black population, see where we can make a difference and make it over a period of four to five years and say we're going to make that inequity zero, not reduce it by 10% percent or 20%, it's going to be zero. We're going to eliminate inequities. That's the longer term view that I feel we are blessed in the sense that we are for not-for-profit organization. Our group that we're answerable to is not our shareholders, it's our members. And honestly, it's also our employees.

      Brian Urban (15:35):

      I love, you can't see it because I wearing a shirt, but I got chills when you said the humanity benefit. If you take that lens, and I think it's a very difficult lens for a CFO of a health plan to often take when they've been in their role for many years and they're a traditional health plan financial leader. But when you look at a next generation type of medicine, next generation type of health plan, you have to look at addressing someone's needs outside of clinical needs or outside of a clinical interaction or claim. And it comes with using your ability to engage with your members and address inequities by race. And we're talking by race in particular because of the socioeconomic status of by race has widened significantly based on different geographies and income levels and education levels and it's all access. So I love everything you said, Romilla, that was just powerful.

      (16:35):

      And I'm curious too, Sharon, from your perspective, because when you're looking at medication access, you're looking at adherence access and then you're looking at, well, what's the culture of health maybe mixed within it as well? So Black/Hispanic populations have a different culture of health view on medication than other populations as well. I'm curious how that's within the health equity strategy as well, or is it just it's not a call-out, but you have two or three hard metrics you're trying to move? I'm curious of how you see cultures of health being involved in your health equity. Has it made your clinical staff change, your care managers change their approach entirely or just begin to evolve?

      Sharon Jhawar (17:25):

      Yeah, that's a great question and absolutely, as we're helping each and every member get the most out of their healthcare, their culture matters quite a bit. And so as we were helping, for example, our Hispanic members, a lot of them believe in natural remedies before they move to medications. And so understanding that viewpoint and matching it to where they are in their diabetes care and having those conversations to say, "Let's try this and if it's not meeting where we need you to be to manage your diabetes, then we should think about medication." And getting them in tune with how to best manage their diabetes, for example, that's a part of the care process. And I think that everyone, as we're looking to improve the equity of care, you have to take into account one's own culture and what their beliefs are. And so that was a heavy part of this process.

      (18:27):

      I do want to go back to, Brian, what you were saying about the chief financial officer and looking at the return on all of this work that all organizations are doing on equity and push us a little bit. Romilla mentioned we're a non-for-profit. A non-for-profit like SCAN, we operate on half a percent, 1%, and we invest everything back into our benefits for our members. But if you think about other insurers and for-profit insurers, they're operating on 7%. So can they invest money to solve the inequities in healthcare? Absolutely. It's totally possible and we're just paving the way, showing how a nonprofit's doing it, but it's completely possible for all of us.

      Brian Urban (19:10):

      I love that. The leaders that listen to our little podcast here, from a financial perspective, you're laying out the strategy. You are a very resourceful, not-for-profit institution operating on that percent and your margin goes back in to health equity investments. Can you imagine, like you were saying, a lot of these other health plan organizations that have a much larger margin, what they could do? And I think it's going to take a public health, a humanity health army to start to generationally change the approach that a lot of health plans, healthcare, pharmaceutical manufacturers, health technologists are taking, that it can't be such a power profit driven mission. It has to be able to actually change the population in a health sense, in an economic sense, or else we're going to keep doing the same cycle and fingers are going to keep getting pointed back and forth.

      (20:08):

      This is the strategy. Our listeners, this is the roadmap. And actually, a good question for you both. When you were designing your health equity strategies and you look at a multi-year view, are you taking a little bit of risk in saying, "Hey, we're going to learn as we go, and if we fail, we're going to learn from that and pick up and go?" Or is it a very precise risk mitigation plan that you're afraid to go to certain areas and invest in certain programs for certain populations? I'm curious what you think about with financial risk or strategy risk mitigation when you're putting this together, because I think that's a big hesitancy for other big plans, Blue Cross Blue Shields or private plans, is, "What can we get an easy win on that won't dent us, but it'll move the needle for health outcomes or reduced hospitalizations?" I'm curious of your look at risk when you're developing your health equity strategies. Romilla, let's maybe start with you on this one. It's a big question, I know.

      Romilla Batra (21:11):

      Yeah, I'm going to talk about how we are doing it and then maybe, Sharon, you can talk about our experience in 2021. I think the big thing I want to make point off as well, we talk to a lot of folks who come up with a lot of things they can do. There is no playbook that you can take. You cannot pick it up a shelf or say this is the best practice, I'm going to run with it and this is how we're going to do it. And so the approach we are taking, and that's why we have the multi-year focus, is that we are going to learn. We'll try a few things. We'll fail fast, but at least we would've tried. Some of them will help us move along, some will build on our past experience. And so our 2021 is a good experience to learn from.

      (21:50):

      What matters most, and I've learned from Sharon the most is, trust in general when we do our outreaches, it's one call, two call, you take care of things. When we are engaging with these populations who've been left behind for so many years, it's not one or two calls, it's like multiple calls or many months just to get to build that trust by starting with what matters to our member to get them to even talk about their diabetes, to get them to even talk about why they're not taking the medication adherence. Our view of this is it has to be a commitment, and the commitment not only comes from our leaders, it comes from our board of directors who are encouraging us and pushing us in this multi-year journey. So I would say throughout the organization, there is this pursuit of the possible, what can be done. And yes, there is no one silver bullet or a gold bullet. You have to try many things, fail, fail fast, learn, get up and do more of it.

      Sharon Jhawar (22:45):

      Yeah, I think we knew going into this that there were going to be aspects that we were going to try new things and we were going to fail. And we were given that grace, that it's okay to fail at things. And like Romilla said, fail fast and keep going. And so in 2021 when we started on the medication adherence front, there were things, the cultural pairing, that was a positive. When we heard some of our members struggling with getting to the pharmacy to pick up their medication and we tried to do the Uber delivery of prescriptions, what we found in trying to get that up and going, it wasn't fast enough. That by the time we had coordinated the delivery and got the medication ready to get delivered, someone in their family had already gotten to the pharmacy and picked it up. And so that was a failure.

      (23:35):

      Which we tried our best, but we couldn't quite get it fast enough. And so as we carry forward, another piece like we were talking about, trust. That thing, building trust, especially amongst our black members, takes a lot of time and sometimes telephonics is not going to work, even if you're calling 18 times to build that trust. And so we have to be able to balance when over the phone works, when do we need to be in person to build that trust for then, us to make a dent in improving their healthcare. It definitely is a process, definitely failures along the way, and then it's just constantly refining and getting better. But I think we learned a lot of things on the medication side that now we're applying to improving flu vaccination rates in our black members, as well as diabetes control for our Hispanic members.

      Brian Urban (24:33):

      I love that you both admittedly say, "We have failed, we're probably going to fail, but if we keep going, then that's the goal, then we're going to have progress over perfection. We're going to have progress toward achieving more equitable access to care, medication access, food, transportation, vaccination." It's endless if you have that perspective. And I think a lot of health plans and other entities too, is if you fail, it's a public thing and it looks bad, and you have to pivot to something else quickly to change perspective on you from an external viewpoint. But that's not the case, especially really for you both, really at a public health, a population health driven mission.

      (25:22):

      Something that, Romilla, you said a moment ago is making me curious to talk about something I saw was so interesting, that humanity play. RIP Medical Debt, a huge debt abolishment philanthropic innovator that came from two folks that were actually collection agents that formed a nonprofit to abolish medical debt at the individual and family level. And they're a bridge, they're an intervention, they're not a solution, but they actually helped influence policy change at the federal level as well, for what's reflected on someone's credit report in terms of being able to see medical debt and that negatively affecting you.

      (26:09):

      So RIP Medical Debt, you just gave a contribution to them in June, and it turned out to have $110 million abolishment of medical debt for individuals and families. I think it was over 60,000 people, it was unbelievable impact. I don't see many other health plans doing this. A lot of organizations do campaigning, there's angel donations. But how did this opportunity come to you all and why did you decide that it's time for you to show everyone else how to put your money where your mouth is when it comes to health equity? Medical debt is definitely, it's a public health challenge. So how did this investment opportunity come and how did you do this?

      Romilla Batra (26:55):

      Yeah, when we look at what our responsibility is, our mission is keeping seniors healthy and independent. It's not keeping SCAN seniors only healthy and independent, it's all seniors healthy and independent. And when we look at the societal problems that are really interfering in people living their life to the fullest, homelessness is one of them, medical debt is the second one of them. People not understanding how to take their medications, a third of them. So what we decided to do is not just put all our things in one basket, which is how do we improve the inequities in our member? It's very, very important to us, we want to do it. We wanted to take a step back and say, "What else could we do?" And so out of it came, what are the things that are driving people in not achieving their fullest outcomes? And medical debt was a big one.

      (27:40):

      And if you look at who bears those medical debts, these are people who are disproportionately more Hispanic or disproportionately more black people who bear that debt. About 70,000 people across Arizona, California, Nevada, Oregon, Texas, these are the communities that are going to have that medical debt wiped off. That was one initiative. The second initiative I would say is homelessness. If you look at homeless population, California is unfortunately leading the way in homelessness. And if you look at what is the fastest growing population within the homelessness, these are folks that are one more time, black, and these are older adults. And so what did we decide to do? Not only are we going to serve our own members who are experiencing homelessness, we started a new organization called Healthcare in Action, which is a street-based medicine team that one more time, is focused on homelessness with a lens towards equity.

      (28:33):

      And they're serving all folks, they're not SCAN members only, they're serving SCAN members and LA Care members and Molina and others on the street as well. So one more time, it comes from a viewpoint of us having this as a strategic focus and having that mission driven culture of and what else are societal problems? And nobody's raising their hand to solve, that's where we should go. I always tease, we are going in the direction of the fear. People are running away from them. We're going in the direction of fear. We enrolled, I think 10,000 new Korean members last year.

      (29:07):

      And the year before that, I think half our membership that we enrolled lived in highly vulnerable, social vulnerable index areas. 50% of our population were in the highest social vulnerability index areas. One more time, while people are shying away from picking those at-risk populations, we are saying, "Not only do we want to serve those members, we want to serve all those kind of lines. Whether they be clients or patients or seniors, it's our responsibility to serve them."

      Brian Urban (29:33):

      Again, that is the humanitarian investment and it's really a portfolio. I'm actually seeing SCAN having more of a health equity portfolio, it seems like, because you have so many different investments initiatives, the healthcare in action team, the RIP Medical Debt. Really, it seems like it's a contribution perhaps, one of maybe many or several in a series, it seems like. And then also your diversity in populations is incredible. You don't see that across other health plans, unless health plans are looking across more of a national lens, not just through four states or five states. That is amazing. And Sharon, would love to hear from your perspective as a previously behind the counter, practicing pharmacist and now you play one on TV kind of here, so it's kind of funny looking at the lives you've served.

      (30:31):

      And I think all pharmacists have a very close touch to almost social health and being able to engage in an intimate way, than maybe some other medicine practicing physician. And when you think about debt being abolished, that once was a barrier for people to want to utilize healthcare and now maybe just relied on it in an emergency's sake, I'm interested from a pharmacist perspective, how do you see this changing behavior in your members or in the lives of Arizona, California, Nevada, Oregon and Texas? How do you think their behaviors and understanding or perception of healthcare has changed, now having that debt removed?

      Sharon Jhawar (31:17):

      I think it's a huge weight off their shoulders when your debt is abolished and in being able to actually focus on what matters and that's your health and getting the access to the care that you need. In everything that we work on, it's really to put your health first. Even on affordability of medications, that's a huge challenge as well. And a lot of people can rack up debt on that as well. What we work doggedly on is making sure we can bring affordable medications to our members.

      (31:49):

      At SCAN, 90% of the medications our members take, we provide for a $0 copay. And we work tirelessly to say, "And what more can we do?" So that they are not worrying about the cost of their healthcare to take care of their health. And affordability and accessibility, those are two key challenges that we continually see that we are being dogged around being advocates for each and every older adult.

      Brian Urban (32:18):

      That's beautiful and you can see that barrier being removed. And it'll be interesting to see, as Romilla, you said, we have to look out. I mean, you're not going to see a change in the health equity investment for your members in 6, 9, 12 months. We're talking about the human condition and human behavior. It's going to take more than a year, it's not turnkey. It'll be amazing to see the rewards you have from RIP Medical Debt, that donation, that removal of medical debt at the family individual level and then all the other programs you were discussing. And it leads me now to think about I think one of the most unique health plan coverage policies that I've ever heard of.

      (32:58):

      I'm coming from Pennsylvania, there's maybe two big health plans in this area. They've been around for a long time and it seems like other health plans are starting to mock this idea of an LGBTQ+ focused health plan. And it's to address the unique needs of this growing population throughout the country and really the world. But you all have seen this as an opportunity to provide better care coordination, better benefit coordination, and just more customized health plan. I want to understand a little bit more about this and how it's being received by your physician network, by your members. Romilla, can we start with you?

      Romilla Batra (33:45):

      Yeah, it's interesting. As we were talking about collecting data, a few years back we decided to ask our members if they would share their SOGI data, sexual orientation and gender identification data. And what's interesting, everybody was worried what we would hear, and so many of our members came forward and said, "We trust you. If you're going to use this data to make our care better, we definitely want to share with you." That's where it started. And with the startup, we've realized there's so much potential there and we decided to design this product, which we call Affirm. One more time, to meet the needs of older adult population, that LGBTQ+, because feel left behind. And interestingly, as we were planning to design the benefit, our sales team does a sales projection, we were excited if 100 people signed up for it because we were trying to be pioneers and just take the first foot forward.

      (34:31):

      And lo and behold, if you fast forward to now, we have close to almost 1,000 members who signed up. And the other interesting part of the whole thing was we were noticing more people, generally most of the people signed up through a broker channel, but more and more people felt the need, were signing up on their own. They saw this as a unique opportunity for them to improve their own lives. They saw this as a unique opportunity because nobody else was offering that to them. And so we feel very proud of the fact that we were able to offer something that met their needs. And they for the first time, felt they were heard, for the first time felt that they were somebody who was advocating for them. And for us, it's not our secret sauce. We want the whole industry to copy us, because one more time, our mission is to keep all seniors healthy and independent. So hopefully, many more people will copy us.

      Brian Urban (35:20):

      I hope so as well. And that's just, again, it's a portfolio of health equity. It's unbelievable. I hope that is a true fate for an Affirm-like product for other health plans because then you're really paying attention. I think it's always been like, what can be a big plan that gets a ton of members, tens of thousands? But if you focus on those that have really unique needs, that's a different lens and that's probably a better way to have a health plan coverage for a population, based on what they need. And it's a good testament that your members trusted you with their sexual orientation data and how it could be used for good.

      (36:05):

      I absolutely love that and admire that. We've talked so many areas and avenues of your health equity strategies. I want to take a couple steps into the future, Sharon and Romilla. Let's look maybe two or three years down the road. You're starting to see outcomes, positive metrics, things being moved, perhaps people copying your strategies for health equity. What do you think in the next three years will be your greatest achievement or progress in health equity for your members? And with that, what future contributions do you plan for trying to progress health equity?

      Romilla Batra (36:55):

      Sure. Just like I said, for us, we serve 300,000 members and yes, we want them to have no inequity gaps, want to eliminate those gaps. And yes, we are starting small with a few areas, but hopefully we'll continue growing this muscle and make it many more areas. All our programs will start with equity first, versus a few programs that are dedicated to it. But I think most importantly, we are hoping to inspire the rest of the healthcare industry. And by that I mean not only health plans, but hospital system, provider groups, our vendors, our pharmaceutical companies, so they can come alongside and do more. Do the action part of it versus data collection part of it.

      (37:32):

      And so for us, success is not just that our members have the best outcome. Our success is more and more older adults and more and more vulnerable adults in our communities. And the communities beyond us have better outcomes because they've learned from something from us, because we inspired them, because we challenge the status scope for them because we showed them it can be done. And I always want to close by saying SCAN stands for Senior Care Action Network. So action is in our middle name and we want everybody to do that, have action and do something about it.

      Brian Urban (38:04):

      Thank you, Romilla. Beautiful. Sharon, what do you see in the future? What's going to be the biggest needle mover for you all?

      Sharon Jhawar (38:14):

      Three to four years out, I see SCAN eliminating the inequities that we currently see in diabetes care and medication adherence and flu vaccination rates. That's going to happen. I think that Romilla and I are going to sit back and we're going to say, "Hey, did we improve healthcare the way we want it for our moms and dads?" And the answer is going to be yes. There's a lot for us to still tackle, but I think a few more years out, will we have improved it in a meaningful way? Absolutely.

      Brian Urban (38:49):

      Brilliant, brilliantly said. I am just blown away. I thought we were just going to talk about fun health equity stuff. We got deep today and I truly hope this inspires the rest of the healthcare ecosystem to do their part, to make their contributions and to start getting us some notable progress. Romilla, Sharon, thank you both so much for joining the show. And for more insights and excerpts, please join us at finthrive.com.

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