It’s not every day the CEO of an $8 billion health insurance company launches a massive ad campaign explicitly titled: “Health Insurance is Broken.” But Dr. Sachin Jain is not your typical CEO.
In this week’s episode of Good Medicine, I was thrilled to sit down with Sachin, the CEO of SCAN Health Plan (a not for profit Medicare Advantage plan). His career trajectory has been dizzying—with stints at CMMI working in the Obama administration to leadership positions at Merck and CareMore to being a regular contributor at Forbes magazine. Across these experiences, he has built a reputation for unapologetic candor, a willingness to take risks, and an “Eye of the Tiger” underdog mentality.
This interview was fascinating. Sometimes, conversations like these can devolve into predictable bromides, carefully tailored to fit the contours of approved corporate messaging. Sachin though, was refreshingly introspective when it came to his industry’s role in the current health care affordability problem. He insisted that the health insurance industry had plenty to answer for—and challenged the entire healthcare industry broadly to stop pointing fingers at each other and start owning its failures.
We also explored what happens when doctors cross over into corporate leadership, the ways we can actually solve the prior authorization nightmare, and why his organization took the unprecedented step of suing the federal government.
Other highlights from our conversation:
1. The “Physician Executive” Trap
Sachin points out the sometimes sad evolution of doctors who enter the insurance industry and become complicit in a broken system. For example, he points out the absurdity of a national payor limiting a post-heart-attack (STEMI) hospital stay to 1.4 days. He argues that physician executives carry unique ethical & scientific obligations: they cannot hide behind administrative ignorance. Instead of becoming enforcers of “dumb policies,” they must act as translators who proactively center clinical reality in any business or operational framework.
2. The Cure for Prior Authorization: Delegated Risk
Prior authorization is universally detested by doctors, but absent any checks, Dr. Jain notes that health insurance is effectively a “blank check” for unnecessary testing and treatment. His solution? Health insurers should get out of the prior authorization business altogether. Instead, they should delegate financial risk directly to provider systems and let doctors police their own utilization. At SCAN Health Plan, 92% of their covered lives exist in these global risk arrangements, creating “soft UM” (utilization management) where care decisions are made collaboratively within the clinic, not by a stranger sitting in an office denying claims.
3. Loneliness is a Medical Condition
Long before loneliness entered the current public health lexicon, Dr. Jain recognized it as critical unsolved problem in health. In medicine, though, conditions often don’t “exist” until there is a treatment for them (much like how osteoporosis wasn’t widely diagnosed until a drug was developed to treat it). So, he built the “Togetherness Project”—a massive, scaled clinical intervention utilizing friendly callers and visitors to “prescribe” human connection. The result? Patients who received the intervention showed improved clinical engagement and preventive screening rates.
Also in this episode:
- The story of why he decided to sue his former employer (CMS) over Star Ratings calculations—and how that underdog victory secured $1.4 billion for over 60 health plans nationwide.
- Why he views traditional Medicare as a “rich person’s program” and defends Medicare Advantage as an essential social safety net for low-income seniors. For those of you who saw the viral Jon Oliver takedown of Medicare advantage, this is essential listening(Sachin btw responded to this in real time here)
If you are fascinated by the friction between payors, providers, and patients, and want to hear from a physician leader actively trying to fix the system from the inside out, please join us for this conversation.
If you’re a US-based physician, continue the conversation with Dr. Jain on Roon!
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