Episode Transcript:
Eric Hunter:
Every percentage point is a human being. And if we think about it that way, then your motivation is to lift all boats.
Sachin Jain:
And that's the way health care should be delivered in this country. It should be about people.
Robert Traynham:
Hi, everybody, welcome. Welcome, Eric. Welcome, Sachin. I want to start first and foremost with an icebreaker. I love these type of opening questions because I think it sets the tone. Favorite sports team, Eric? (Or genre.)
Hunter:
Well, I think favorite sports team for me has got to be the Pittsburgh Steelers. I grew up born Aliquippa, Pennsylvania outside of Pittsburgh. My grandfather worked in the steel mills. So, the Steelers — not only were they the hometown team for him and the family, but they just epitomized hard work, blue collar, and community and that's what I’m attracted to.
Traynham:
And so you know, I have a follow up question to share because you’re a Pittsburgher. I.C. Light, Original O? Are you following with this stuff?
Hunter: Nah, I’m a vodka guy.
Traynham: Oh, you're a vodka guy, okay. I.C. Light is a local Pittsburgh drink. Sachin, you?
Jain:
New York Yankees.
Traynham:
Why?
Jain:
I grew up in New Jersey. So, like any good New Jersey person, you have to like a New York sports team. And I grew up in the 80s when the Mets were cool, and the Yankees were the underdog. Some people find it hard to believe that I liked the Yankees because they were the underdog but they were the underdog that made it. And that era, the early 90s, late 90s, early 2000s is very special.
Traynham:
You know, what's really interesting for me about sports teams is that there's an affinity there like, it's, you live and die. I grew up just outside of Philadelphia and the Eagles fans are and were very diehard. In fact, I don't know if this is still true, but the stadium in Philadelphia, Veterans Stadium, actually had a jail. And a judge. Have you heard the story? No? Only because apparently Eagles fans were so raucous — rowdy — that there was actually a jail there. I don’t know. Have you heard the story?
Hunter:
I mean, they threw batteries at Santa Claus…
Traynham:
That’s true. That’s right. That’s right. Yeah, we’re not… us Philadelphians are vocal.
Jain:
Well, now you can't even get into a sports game without a couple hundred dollars in your pocket, which is, you know, an unfortunate turn of events.
Traynham:
Yeah, it's no longer a blue collar, you know, middle class sport.
Jain:
Yeah. Sports in general. It’s gotten too expensive — like health insurance.
Traynham:
Let's talk about that. That's I think, that's a perfect segue. So, you both are the president and CEOs of two companies. I know you have some news to share about what may happen. But let's talk more about health insurance and policies and the expense and how you tackle that. So, let's start with you, Eric.
Hunter:
You know, at CareOregon, because we're predominantly a Medicaid plan (we’ve also got a dual eligible plan and in-home primary care, hospice and palliative care, but we’re primarily Medicaid.) We are completely dependent on policies set up in Washington, and in individual states, on what the provision of health care has to be. Right? So our goal as a community- based not-for-profit is: how do you take those required goals and couch them in a way that they actually serve the population with the needs the patients have? And that's really the biggest challenge, I think in the health care space, for us it’s saying, “let's get out of just counting widgets.” These are not widgets, they're human beings that have particular needs. And profitability is nice, I suppose, if you need to keep the doors open, but that should not be the motivating factor. It should be doing what's right for the members, and what they decide that they need. And that's really, I think, the focus for us in CareOregon and I think if the entire industry worked with that mindset, we'd be in a much better place right now.
Traynham:
So, Eric, I hear you say there's a mandate coming from above. And what you try to do at the local level, is personalize that because these are humans. These are lives behind these policies, for lack of a better term.
Hunter:
Exactly. Exactly.
Jain:
So, I lead SCAN group and health plan. We were founded 46 years ago by a group of people we affectionately call the “12 angry seniors,” and we keep the 12 angry seniors front and center in our thoughts about our work, because these were a group of people who said that they wanted to remain healthy and independent and in their homes. And that is our founding principle. Not serving shareholders, not creating profits to fund whatever and whatever else. And that's the way health care should be delivered in this country. It should be about the people. People like to equate health care to all kinds of other goods and services. You know, we are not Netflix. We are not Disney. We are the health care industry. And we're proud to be the health care industry and we're proud to be different, and we're proud to exist for the people that we serve. And we think that that's really, really important. We both represent not-for-profit organizations. Not for profits are not the only organizations that can operate this way. But what we see is that more often than not, not for profits on the margins, put patients before profits. And we think that that's really, really important when you think about how you take care of frail and vulnerable people.
Traynham:
You know, what I'm hearing is, values. I'm hearing mission. I'm hearing this is really leading from the heart in a way that is personal, in a way where you're developing a relationship that hopefully is built on a level of trust. And also, that is clearly predicated on people's health and their lives. So, this is serious stuff in many ways. So, thanks for sharing. I understand you have some news to share. Would you like to share with us what that might be?
Jain:
Well, we've shared it before but not in this setting. We are coming together.
Traynham:
Tell us more! Are you getting married? What's going on?
Jain:
We are getting married. We are getting married.
Traynham:
Two missions, two values, two companies, two not for profits coming together?
Hunter:
That's right. That’s right. We talk a lot about the fact that this is a little different combination, because in this case, it's not one plus one becoming one bigger one, as is often in this industry. It's one plus one equals three. We're going above and beyond simply the combination of two companies that have like missions and like values and saying, “Where do we take the next steps to do those next, innovative things that enhance what we currently do instead of replacing what we do?” To take, to be that disruptor that the system really needs, but a disrupter that's focused on the work from a human perspective, right, the not-for-profit perspective, and really gives an alternative to the communities and to the behavioral health nations and the governments to say, “Hey, where can we go besides the for-profit motive to really engage people in health care,” and we think we can take that and do really good things with it.
Traynham:
I assume you agree?
Jain:
Absolutely. And we're going to call ourselves the HealthRight Group. And we chose this name very deliberately because we both, both of our organizations, really see health as a right. And there's a way of doing it, right. And so that double entendre is really, really important. You know, we're going to continue to operate from a consumer-facing perspective as SCAN health plan and CareOregon in the markets in which we already operate. But our corporate parent will be called the HealthRight Group and we're, we couldn't be more excited because we think that the moment is now for, I think, not-for-profit organizations to come together to sustain themselves. You know, these are two strong organizations, but we live in a world where it's really becoming David versus Goliath. And, we've got big national for-profit organizations — you know their names — you’ve got smaller venture capital and private equity-backed companies that are doing irrational things to try to gain market share. And so, there's this risk of those of us in the middle, not-for-profits and community-based, mission-driven — that we get lost. And what I think Eric and I realized from the very first conversation that we had about this — almost three years ago now, Eric — is that there's a there's a different way, there's a better
way, and that's why we're here.
Traynham:
It sounds like you both collectively, but also separately, serve underserved communities. It also feels like, clearly as I mentioned before, there's a lot of mission and values driven in your work. Tell me how this will work in the future. I know you alluded to it a little bit, but if you can be more specific around where you overlap in terms of your interests, or is it going to be pretty much separate?
Jain:
So, I think you know, the company is really going to be organized into three different divisions. There's going to be a Medicare division, which will be kind of our legacy SCAN health plans so to speak. There'll be a Medicaid division that Eric is going to lead and CareOregon will be one of the divisions of the Medicaid division, and then we'll have our diversified businesses. I think between SCAN and CareOregon, we have six or seven diversified businesses that really solve unmet needs in the health care ecosystem, really in the care delivery space. And so, we're excited to see the art of the possible play out there.
Traynham:
I want to turn to you, Sachin, for a moment. As I understand it, the New York Times, as well as USA Today had a really interesting profile story about some of the work that you have been working on, your company has been working on. Explain, please.
Jain:
So we have this epidemic in plain sight on the West Coast and really in the United States, which is the epidemic of people experiencing homelessness. And a couple of years ago, we took a hard look at this and said, “we've got to do something.” And so, with the support of our board, we decided to launch something called Healthcare in Action, which is a medical group that is focused on people experiencing homelessness. And our goal is to try to rethink the health care cost equation. We talk a lot about value-based care in this country. And one of the populations that's, I think, most suited for a value-based care approach is actually people experiencing homelessness. As a country we spend hundreds of thousands of dollars on emergency room visits, hospitalizations, ICU stays, but we don't do any of the things upfront that we need to do to support people. And what we know is that homelessness is both caused by health problems but also exacerbated and extended by health problems. And I think how you define a problem actually influences how you solve the problem. And we have failed to define homelessness for what it is. For some subset of people, it is actually a health care issue. It's not a housing supply issue. It's a mental health issue. It's an addiction issue. It's an untreated chronic disease issue. And so, you know, we believe that problems need to be solved in their roots. And so, our approach has been to actually create Healthcare in Action. We have over 11 Street medicine teams now, all over California, ranging from San Mateo County to LA County, Orange County to San Diego County. And so, what we're doing is really building a movement around addressing homelessness, through its health care roots, and that's what I think caught the attention of the New York Times and USA Today.
Traynham:
I'm reminded of a conversation I had a couple of years ago when someone said, “Homelessness is really an iceberg.” You see the tip of it and you think you have a lot of preconceived notions about that tip. But underneath, to your point, there's so many other foundational issues that could be going on that are usually undiagnosed.
Jain:
And this is an issue I've been working on personally, since I was an undergraduate student, medical student. Started a homeless health clinic that many years ago. What I think the innovation here is, though, it’s that we're starting to think about how do we actually take the total cost of care, the literally hundreds of thousands of dollars that can get spent on what is ultimately avoidable medical care, and then move it to provide actually intensive street-based primary care and behavioral health. We're not — by no means — like the only folks who are doing street medicine, but I think what is innovative here is the payment model that we're trying to attach to it. There are some phenomenal people in California doing this work, phenomenal people in Oregon doing this work — Central City Concern is a group we both, I think, share a ton of admiration for. And so, what we're trying to do is actually build the payment model and the evidence base to be able to actually sustain these groups because a lot of these groups you know, end up fundraising through grants, you know, trying to get pieces of legislation passed to support themselves. But we think that there's a ready-made mechanism to actually fund these groups today, which is to reallocate the dollars that we're spending on ultimately avoidable medical complications of homelessness and provide intensive primary and behavioral health.
Traynham:
Eric, I want to transition to health equity. This is a new phenomenon, I think, for our society overall and having these health equity officers installed and insurance provider plans as well as hospitals and so forth. But I think it's really challenging to hold these new positions accountable when the data is still coming in in real time. I understand you think about this a lot. What is your thinking around this?
Hunter:
You know, I think you mentioned the iceberg scenario. For many places, the chief equity officer should be like an iceberg, you know, just sort of the visible part, you see, but there's so much more substance beneath it, that really drives it. But for many companies, it's a floating… just piece of ice. There's nothing to it. It's performative. I think.
Traynham:
And it's not tethered to anything. In theory.
Hunter:
No. It floats around whatever. Whatever the issue of the day is, is what they address. A lot of companies are great about putting out letters and statements, but when you say, you know, “But what is your C-suite comprised of, right? Who's in the room when you're making decisions? How do you engage communities to hear their voice? Not just survey them and say, “Hey, we ran a survey,” but sit down with them and say, “Let's talk through the issues, engage in community groups that are specified to work with particular groups, whether it's the immigrant refugee communities or the African American communities or Hispanic Latinx communities, engaging them on their turf, on their terms, in their language, to understand what their needs are, and then building your processes and programs off of that. So often, people believe equity is just simply understanding disaggregated data and saying, “You know, this group has this percentage this group has that percentage.” Every percentage point is a human being. And if we think about it that way, then your motivation is to lift all boats. Right?
Traynham:
Right on.
Hunter:
And hopefully, everyone will come along and you identify those places where that's not happening and you address that specifically. So really, I think, you know, when we look at, particularly for government programs, anyone that is engaging in the health care system, is in a vulnerable population, I think. So it's making sure equity also does not leave out those folks because they don't fit into some clean category. Everyone deserves to have the proper, appropriate health care that's socially responsible, that's fiscally prudent, right? We have that to do as well but engage at the level of what they truly need. And that's how I see it.
Traynham:
Any response, Sachin?
Jain:
Well, you know, we've been on a journey at SCAN. I would say when I started in the organization, you know, three years ago, and several board members said to me, “This has been a high performance organization, but we're not satisfied with the fact that we are not serving kind of more diverse populations.” And so, we've been on this journey, both to expand our reach into new populations, new communities, but also to really enhance our product offerings to serve communities that otherwise aren't being served. I think there's lots of efforts underway. I think Healthcare in Action is a really good example. We've had initiatives around, you know, reducing disparities and medication use in different populations, our African American patients, and Hispanic populations. But I think, you know, the thing I'm most proud of is probably our product innovation. Last year we introduced the first ever LGBTQ+-focused Medicare Advantage product called the SCAN Affirm product and recruited over 600 members to that product, which for those of you who aren't familiar with Medicare Advantage product launches, I mean, 600 in the first year is awesome.
Traynham:
That's a big number.
Jain:
It's a big number. And it's growing. And, you know, we're doing things like providing people with enhanced behavioral health support, a formulary — that is a medication formulary — that’s tailored to their needs. So most importantly, we're letting people know that we see them, we respect them, and that we're there for them. And I think as an industry — I would say let's just call it what it is — our industry has not seen America for the diversity that it is and we've not built products that actually speak to diverse communities and populations. We have not built marketing materials that speak to the broader population of Americans. And this is both a melting pot and a salad bowl and pick your favorite you know, analogy, and we have to speak to everybody. And you know, I think one of the things that the Affirm product did, which lots of people were skeptical about to be really candid with you, when we launched it, is it showed us that, it's not only the right thing to do, but it also unlocks growth. And, I think there's people who are waiting to be spoken to, and that's, I think, our obligation. And to Eric's point, I'm so tired of the sort of ‘virtue signaling’ that comes out of, the large American corporations. You know, George Floyd gets murdered, everyone sends out, a press release saying that black lives matter, they make a donation to their favorite charity. Three years later, everything's the same. Our C-suite is very diverse. It represents, largely, the community that we now serve. And I think that it allows you to make better decisions and allows you to have those voices in the room and also we're having a conversation about what voices aren't in the room that we should have in the room. And I think it makes it makes a big, big difference in terms of just whether you're running a 2023 company, or you're running a 1955 company, and I think we're trying to run a company that meets the needs of people today.
Hunter:
I just want to follow up I think, you know, what Sachin just talked about, is the reason that we said it makes sense to come together as companies, right? That mindset that there is a way to do better, that populations and individuals and communities deserve a health care system that serves them. With CareOregon, we now do a tribal care coordination program. So that partnership with the nine tribes in Oregon, the state, and the federal government to provide care that's culturally responsive to our tribal members who weren't being properly served, and then we just recently started an Indian managed-care entity with native partners, because that's what they needed to serve those populations and to be willing to go sort of out on a limb and to create those new programs that Sachin talked about that are geared towards making sure everyone has the same opportunity for care. That's critical.
Jain:
And let me say the other thing. The reasons we're doing this is both to do it ourselves for the people that we serve. But we also think that our industry needs some inspiration. And you know, the two of us are going to take it on and we're going to show people the art of the possible.
Traynham:
So, you're the beta test, you're sticking your neck out there in a good way, and figuring out what sticks, it sounds like. I want to double down on health equity. I think this is so important on so many different levels. You know, and one of the things that I think is there for certain people, they're making these decisions, not through a health lens, they're making these decisions through a financial lens. And the burden that some people carry when it comes to that is, “Gosh, how am I going to pay for this? Am I going to put this on my credit card, a second mortgage,” or whatever the case may be? My understanding is you both made some news here. What is that, Eric?
Hunter:
I think, we were so proud to be able to come together and collectively work with a company called RIP Medical Debt to retire the medical debt. Over $100 million worth of debt was retired in the states in which we work for people that have just been trying to sort of get by, I think, and we say it's an equity issue because it truly is identifying a stressor that people have in their lives. And we've talked about social determinants and those things that impact health – financial issues and those stressors are important. People need the freedom to say, “I'm going to get the care I need; I can't have money be a burden,” and I think it's an amazing program.
Traynham:
So Sachin, I'm going to go back to this, this is a big deal, right? Because at the end of the day, you're talking about people's credit scores, you're talking about their ability or inability to perhaps maybe get a car, or a mortgage, or whatever the case may be, and just the overall anxiety about being in debt.
Jain:
Look, when I was a medical resident, I had an attending. His name was Dr. Gordy Schiff. And you know, most of his clinical teaching to us was not about, you know, what drugs work to treat hypertension or diabetes. He kind of assumed we knew that. But it was actually about how to make sure that our patients could afford their drugs. And, I think there's so many people. One of the key lessons from that time was that there are so many people who either delay medical care or forgo medical care, for fear of the bill that they're going to get, for fear of the aggressive collection practices of the health care system, for fear that their credit scores are going to be permanently damaged because they can't pay the bill. And we know people, all of us have people in our lives who have avoided going to see a doctor because they're just not sure what they're going to get on the other side of it. And so, what we've learned is that one of the top causes of bankruptcy in 2023 for Americans is actually medical care. What is this world that we've created? And, I think that's the reason that we are just so proud of this partnership. And we also know that this disproportionately impacts people of color and people in low-income communities who don't know enough to advocate for themselves, to not pay the crazy list prices that they get from doctors’ offices and hospitals for medical procedures, and who then become subjected to this aggressive debt collection. And you know, that, again, we were like this dystopic world and I think what we’re trying to do is raise the visibility of this issue. You know, it’s a couple $100,000 donation, so I don’t want to overstate it, but that was able to retire $110 million of debt. But what I'd like to see from the community of watchers, viewers from AHIP, is I'd like to see every health plan in the country follow our lead. If every one of us actually agreed to kind of pay down, you know, a certain amount of medical debt, it wouldn't take a lot for us to wipe out medical debt. In the same way that I think we saw, you know, some student debt relief recently. So, I think we’ve got to hit reset in some ways and I think our industry could be part of the solution instead of always being part of the problems.
Hunter:
And I think, I think that's great. I mean, and really, it's a call to action, as Sachin said. It’s how do we motivate others to do similar things and then collectively take the next step? Eliminating debt on the back end is one thing, but let's eliminate that debt from happening in the first place. Like, let’s make sure that folks aren't getting balanced bills, that people understand what their needs are, understand how to get on to government programs if they qualify. Those are the kinds of things that will really solve the problem long term,
Jain:
Our classic product, which is our most popular Medicare Advantage product in LA County, actually has a maximum out of pocket of $499. That will keep you out of debt. So again, I think we have an obligation to build products that are affordable, that make care affordable. But I also think if you're watching, if you work in this industry, email your CEO email whoever leads your… and say, “I saw what SCAN and CareOregon did, and I want us to do it too.” And what I'd like to see is I'd like to see every organization or industry do the same thing and let's just press reset on medical debt in this country.
Traynham:
A lot of disruptive and innovative thinking. Really appreciate it. What’s next for your teams.
Hunter:
You know, I think it's showing truly that this matters, right? Again, performative is not a word that I want to ever have associated with anything that I do. We are meaningful. We are deliberate. We are bold when we need to be, but we're going to show it, we're not just going to talk it. And I think that the plans that we have together to bring new products and ideas into the marketplaces that we're currently in — or maybe other ones, right — just saying “Here's how there are measurable differences in the lives of people. In the health of our communities.” That's going to show that we've done something great, and then hopefully that incentivizes others to want to do the same thing, either individually or with us.
Jain:
But let me maybe just double click on this word “performative” because I think we have to talk about what we're really responding to here. I think Eric and I have been in a lot of rooms where people say the right things, but then they walk out of the room, and it's business as usual. And it's what I call the ‘inauthenticity crisis in American health care’. Everyone says they want to pay for value. No one wants to actually live in that system. Everyone says, you know, they care about health equity, but when it comes time to making the investments they don't make them. Everyone says they want a diverse leadership team, but when they go to market and try to hire someone, they say “we can't find diverse candidates.” I mean, we've all been in those rooms and…
Traynham:
It sounds very shallow. It sounds you know, … you're just not being completely transparent. Well, my grandfather used to have the saying, “Don't ever write checks, you can't cash,” meaning, let's, let's be clear, if you could write the check, write the check, but make sure you can cash the check.
Jain:
Yeah, and let me say something about this space. We're trying to undo hundreds of years of injustice. It's not going to happen in a day.
Traynham:
That’s right. It’s systematic, by the way.
Jain:
Yeah, and I think some of our employees are wanting it to happen tomorrow, and I'm grateful for that energy. But, you know, I think this is going to be a journey that we're going to go on and, you know, the way you create differentiation is with a thousand different decisions. And if you make those decisions deliberately, with the right values, and you make a thousand of those decisions, you know, a few years later, you're a completely different entity than where you started. And I think the challenge we have is that there's so many other — so many organizations — that don't even get started. It's one of the reasons why I'm just so excited to work with this guy, is because I think, you know, the two of us are going to be able to accomplish a ton and really, I think, bend the arc of these two organizations in a really positive direction and hopefully, the health of the people and the communities that we serve.
Traynham:
Can you both think of an example where your decision has been so impactful? Where it really has put a human face or human touch on the work that you're doing every day? Eric?
Hunter:
You know, I think the first thing that comes to mind for me is you know, it's not necessarily my work. It's the team's work, right? It's the work of our partners and the community and engaging people in identifying their needs. therein particular, there was a woman that some of our providers identified who had SUD issues, right? Substance Use Disorder, and she was homeless. They engaged her in a way that she understood that someone was there to help her. She had been on the streets for years, had this problem with substance use and then through partnerships of getting her counseling first, and then housing and then later getting clean. She was able to turn her life around in such a way that she not only went to work, actually for one of the agencies that we work with, like maybe these agencies, but she actually was able to get her child back who was in the foster care system. And I think those are the kinds of things that we say, you know, it's not just a number. It's not a percentage. It's a human being. It's a life. It's a family now and that's what it's all about.
Traynham:
Sachin?
Jain:
Yeah, I mean, I'm thinking about a few different categories of people. I'm thinking about the 50 people who are now housed because, you know, of Healthcare in Action, who previously didn't have a home. I'm thinking about, you know, the members of our Affirm product and in particular, I'm thinking about a guy named Robert Guzman, who's one of our members who, you know, called me and said, “I feel seen, I feel like, you know, you understand me and you understand that as a gay man, you know, in my golden years, you are taking care of me in a different way.” I'm thinking about, you know, in particular, the story of an African American man, who did not necessarily want to take the flu vaccination because he had this belief that many of us have, that the vaccination actually causes the flu. And so we were able to, I think, build enough trust with him to let him know that that wasn't the case, and that this was going to be an important intervention that actually supported him. So, I'm so proud of the work, of the folks that CareOregon and the folks in SCAN. I think every day, we're making a big difference in the lives of the people that we serve.
Traynham:
Perfect segue to my last question, and that is the next big thing in health from your perspective, Eric.
Hunter:
You know, for us pretty good in the Medicaid space. We're lucky to be working in Oregon, where we've worked with federal government on a waiver that truly lets us address social determinants of health needs as a part of the continuum of care. Right? So, housing supports food insecurities, loneliness, climate change, right? All these things are now part of our ability to serve populations in the ways that they need to be served, because it all ties into not only their individual health, but their community health. And I think being able to make that happen with community partners – we can’t do it by ourselves, right? We can't. We hand out air conditioners, but we don't make them. We don't install them. We don't pay for the electric bills. But we can identify those people for whom heat instances could be deadly. Right? And then they will live better lives because we engage in that way or, or folks that even in Portland –we get ice and snow more often than we used to, you know, the people that are sleeping outside, how are they served? So, I think really being able to deal with social determinants in a meaningful way and not just saying, “We have a program for these 10 people.” I think that's going to be one of the big things, you know, making that happen and making it real.
Traynham:
I see very innovative thinking in many ways. And I think it's important to stress, look, we don't make the air conditioning or the air conditioners. However, having an air conditioner in the home perhaps could help someone with diabetes or obesity, whatever the case may be. So, Sachin, now to you. The next big thing in health is?
Jain:
I think it's artificial intelligence. Not necessarily for the reasons that I think other people say. I think we have made this industry so unnecessarily complicated for everyone. It's complicated to be a patient. It's complicated to be an employee. It's complicated to be a physician in the frontlines taking care. And we've created that complication. And I believe that artificial intelligence is going to drive simplification. It's going to take things that we used to have 500 people, you know, dealing with reams and reams of paper, and it's going to allow us to reallocate their energies, their most precious asset, to things that actually matter which is connecting with people and humans. And so, I think human connection is going to be really the next big thing, but it's going to be enabled by AI.
Traynham:
Really cool, innovative thinking. Thank you very much for joining us, and congratulations on the upcoming marriage.
Hunter:
Thank you.
Jain:
Thank you very much.
