Health systems, health insurance companies and vendors are exploring ways to use artificial intelligence to revolutionize the industry, but it’s not a magic bullet, according to SCAN Group CEO Dr. Sachin Jain.
The nonprofit Medicare Advantage carrier's chief executive spoke with Modern Healthcare about how the insurer, which covers 285,000 people in four states, is evaluating how AI can fit into its business, how the company competes with for-profit rivals and what the future of healthcare should look like. This interview has been edited for length and clarity.
How is SCAN looking to incorporate AI into its operations?
We've built an AI advisory board with renowned experts in AI, healthcare and the ethical implications of AI. They're advising our internal team on potential use cases and risks.
One of the things that every healthcare organization needs to think about is not just the forward-leaning opportunities but also the potential risks of perpetuating health inequities if AI ends up being implemented at scale.
There's also a lot of noise right now, and AI is a complicated topic. Lots of organizations don't necessarily have native AI expertise, so we're very selective around the vendors that we're partnering with and the kinds of problems that we're trying to solve. We're working with a company called Abridge that is doing some important work on AI in healthcare. But, again, I think one of the biggest challenges to the healthcare industry right now is the signal-to-noise ratio on AI.
How can the SCAN Group best utilize AI?
Healthcare is a service industry. We want to use AI to make service to patients better. I think we can automate so much. There's massive potential for it to take waste out of healthcare, to take friction out of the system, to look at processes that historically have caused people a lot of angst, pain and difficulty, like prior authorization, and to make the care experience much simpler.
What are your concerns about AI in healthcare?
Friends of mine— [Dr.] Brian Powers and [Dr.] Ziad Obermeyer—wrote a paper that looked at some UnitedHealthcare algorithms and identified ways in which bias gets hard-coded into these algorithms. I think there's a widespread recognition now of this potential risk. What we want to do is make sure that we're not exacerbating any health inequities through the use of automation, algorithms and machine learning.
Every couple of years, there's a belief that there's going to be new technology that's going to solve everything. I think one of the biggest challenges that we have is the belief that the solutions are going to come from these disruptive technologies.
What plans does your company have to diversify its offerings?
We're very interested in segmenting our Medicare Advantage products. Last year, we launched the industry's first LGBTQ+ product. What we're really trying to do is stop seeing older adults as a monolith, and really sub-segment the population in ways that we're able to better serve them.
What's the status of the SCAN Group's deal to merge with CareOregon?
The California regulatory process has mostly run to a close, while the Oregon regulatory process is ongoing. Oregon scheduled public hearings on Oct. 12 to hear from the public about their perspectives on the combination, and the Oregon Health Authority and the Oregon division of managed care need to approve the transaction.
We're combining two teams that are excellent and have very different strengths. This is a “one-plus-one-equals-three” kind of transaction. We want to be able to make available better benefits to patients and better service levels. I think it has become harder to compete in both the Medicare Advantage and the managed Medicaid business with deep-pocketed for-profits encroaching upon the territories that we've historically occupied. We're interested in seeing this as a way to keep our organizations healthy and independent going forward.
The SCAN Group and CareOregon contributed to RIP Medical Debt in June. What was the motivation?
We wanted to make a statement to the industry that we're in an escalating crisis of medical debt. At a time when lots of not-for-profits are being publicly exposed for predatory billing practices [and] debt collection practices, we wanted to set a positive example for the industry on actually reducing medical debt.
We wanted to make sure that people were not getting bankrupt in the communities that we operate in. We wanted to make sure that people were not going to have their credit irreparably destroyed by the experience of healthcare. I personally know people who avoided seeking medical care for fear of landing themselves in debt.
What are the healthcare sector's biggest challenges?
This is a broken industry. We originally thought better healthcare policies were going to fix it, then we've spent the last 10 years thinking that tech and retail would fix it.
We have a moral imperative to make this better—not in 10 or 20 years, but today. We have to just stop making excuses, start looking at ourselves, stop being toxically positive about ourselves and the impact that we're making, and start asking: Are we making the difference we want to make in the lives of older adults? And then start challenging ourselves to be better.
Healthcare is one of the few industries where you can actually be really successful and not particularly good. That's going to change when some enlightened leaders step up and say, “You know what? It isn't good enough just to have positive financials. We actually have to be good to the people that we serve.”
What advice can you offer to fix a “broken industry?”
The best healthcare organizations are the ones that take a look at the words in their mission statement, their values and their press releases, and then take a look at their reality and feel uncomfortable about the difference between what's out there and what's inside.
Great organizations thrive off that discomfort. And I would say we're an organization that is increasingly thriving off of that discomfort. I think a lot of organizations believe their own hype and that they're making more of a difference than they actually are when, in fact, they might just be answering the phones and denying claims. That's not making healthcare better or more affordable.