Scan and Sartre Health hopes to achieve through its MA partnership
There has been growing tensions between the health system and the Medicare Advantage program in recent years, with some health systems completely cutting ties with the MA program. This is partly due to administrative challenges and high claims rejection rates.
But last week, an insurance company and a health system announced they were coming together. Scan Group, which offers the MA program, is working with health system Sutter Health to create new MA products in Northern California and eventually develop a joint venture MA Health Plan. The scan serves 300,000 members in California, Arizona, Nevada, Texas and New Mexico, while Sutter Health has 57,000 employees and clinicians and 12,000 affiliated physicians in California. Both are nonprofits.
In the fall, Northern California will have new scan MA products that offer access to Sutter's network of hospitals, doctors, emergency care centers and other services. Members will also receive support from Sutter Primary Care Clinicians.
Then, according to the announcement, the organizations will co-owned and co-design the MA plan in the “near future.” Scan and Sartre will work together to build the planned network, benefits and products.
“This collaboration is just the beginning of our efforts to innovate and improve care and experience for patients with Medicare Advantage,” Conrad Vial, SVP and president of Sutter Health Network, said in a statement.
Being a co-owner of the program will address many of the current issues between many MA insurance companies and health systems, Dr. Sachin Jain, CEO of the Scan Group and Scan Health program.
“Many of the advantages of health insurance contracts are integrated non-transparently,” he said in an interview. “I think what ends up happening is that over time, the program will be involved in many denials of service. The program may introduce new benefits, but then charge the cost of these benefits to the provider partners for value-based care arrangements.… [In the partnership]we have this plan together, so everything will be transparent. It's not that we have a program, they are provider partners of the program. Of course, they will be the provider partners of the program, but they will also be the owners of the program. ”
Jain added that as co-owner of the program, Scan and Sartre Health will work together for the expenses associated with the program as well as sharing the program’s profit and loss.
Although the partnership began in Northern California, the new health plan could surpass the region in the future, according to the announcement. Additionally, Jain’s goal is to have thousands of members in the coming years. Otherwise, “we won’t do our job,” he said.
He also hopes to establish similar partnerships with other health systems in the future.
“The Medicare system is a lot of overhauling, but at the same time our work is to really make the most of the Medicare Advantage system,” Jain said. “Because I think that ultimately gives us the biggest opportunity to make us what is good for patients and what is good for the healthcare system. Our goal is to really show the art of possible. I hope that when doing this with Sutter, we will inspire other health systems across the country to do that with us as well.”
This is not the only MA insurance company/health system joint venture. For example, Hackensack Meridian Health, Horizon Blue Cross Blue Shield in New Jersey and Rwjbarnabas Health have developed the Medicare Advantage program, called Braven Health, which was launched in 2020.
SCAN has also established several other partnerships in recent years. In October, it began a Medicare Advantage program tailored to seniors in Asia, with Astrana Health being the primary provider. SCAN also developed a health plan for LGBTQ+ seniors and cooperates with health.
Photo: Designer491, Getty Images
