"Tech firms must build software that aligns with patient demographics, is usable for them, and delivers outcomes."

Q. Can you tell us about SCAN Health Plan and the populations that you serve?

Josh: SCAN Health Plan is a Southern California based Medicare Advantage plan and we have been in this business for about 40 years. SCAN Health started out as a social HMO and now we are the third largest Medicare Advantage plan in California. Although our firm is a regional plan, but we do have a strong national presence. We are a leader in a lot of the Medicare Advantage metrics. Our scores are usually near the top of the industry. As per customer satisfaction, we have a strong performance in the star rating and are pretty active from a policy standpoint. We recently got a new CEO Sachin Jain and he came on board about seven months ago. And when you look at such incoming on-board SCAN Health Plan, we’ve had a good foundation, really stable, solid company to the metrics. And now we’re really looking at how do we capitalize on that? How do we build up on that and expand upon all the good work we’ve been doing for seniors across California?

Q. How many lives you cover today approximately and what kind of digital programs have you rolled out in the last couple of years at SCAN Health?

Josh: We’ve got about two hundred and twenty-five thousand listed.

In the last couple of years, we have been focussing on consumer-facing technologies and how do we improve that consumer experience. When I joined SCAN Health, we were more focused on a technology modernization program, a lot of our core admin systems were outdated. They were no longer supported by vendors. Also, our primary core admin systems that does a lot of our administration was written in a programming language RPG. We were hundred percent on premise. So, I put in place a technology modernization program, replacing all those core systems and moved to a SaaS-based model. As all the systems are now moving into a cloud environment, we pivoted our focus more on the consumer facing technology.

We have also built our self-service capabilities, to try to minimize the amount of phone calls we get. To enable our members and our seniors, we have provided online channel options to use. Also, we’ve been doing a lot around data and analytics, advanced analytics. Interoperability has been something we have been doing a lot around last year. And with the new CMS interoperability rule, we are excited. We are really trying to unlock data sharing and trying to focus on our contact centre, our touch points with our members in driving innovation and using technology and data to support those areas of our company.

Q. On the provider side, as well as on the payer side of the business, for instance digital front doors, can you talk about what kind of specific high impact features or functionalities or solutions you’ve launched? How is it making a difference, how do you pick what to deploy, and how do you track whether it’s working?

Josh: There’s a lot of technology and a lot of capabilities out there that we can be deploying. So how do you know you’re deploying the right one? The answer is we like to do journey mapping. Looking at what is that member experience, that constituent experience and looking at what are those touch points that we have, what are the areas that have pain points. We call them – the moments that matter and we look at how we can apply the technology to help solve the issue.

Also, we are very focused on a person-centred design. We use our member advisory committees to give us guidance on things that we need to be working on and have our members, our seniors inform us on the things that we think we need to be working on and focusing on. Then we always have a heavy focus on caregivers and really increasing their abilities has been an area of focus for us.

The other thing that had come up around our members was multifactor authentication on our member portal that is protecting their data. To look after this concern, for us, it starts with that journey mapping of looking at what is the experience and what are those pain points that we can solve with technology.

We have a fully integrated broker portal and we look at their experience of interacting with SCAN Health Plan. By streamlining that, we are making it easier to do business with us from a broker perspective. With our providers we are trying to provide them with better experience as well. So, to sum up, our providers, and our brokers, both can provide our members with a better experience.

Q. You are serving multiple constituencies and your population might not be ready for some of the digital technologies and tools. Can you tell us about one or two unique things about your population that you had to take into consideration while designing these solutions and experiences?

Josh: It’s really not a one-size-fits-all. When you’re dealing with the Medicare and the senior population, you got to design the experience with that population in mind. How do you make it simple? How do you make it easy to utilize those technologies? And that’s something we strive to do with our website and any of our touch points with our members, whether it be telehealth, whether it be doing a virtual visit and even getting that virtual visit invite over to our members.

One of the things we’ve seen in particular with COVID-19 is digital adoption skyrocketed even among the senior population. We saw our member portal registrations go up over 30 percent and these are not one-time registrations. We have also seen our virtual visits, our video conference visit dramatically increased. When the pandemic hit, me and my team brainstormed for solutions and tools to help solve the digital divide with seniors and quickly rolled out a member technology support line. We were able to get it up and running for about three weeks but then after the pandemic really kind of took hold as everybody started going into our virtual environment. And the success out of that is when you look at what happened with the pandemic, you and your members were really thrust to get into a digital environment and some of them were ready for it. You can’t generalize the senior population, some are very digitally savvy and some were not ready for it.

I will never forget our first call which was a forty-five-minute call and was very impactful. It was with a 92-year-old member who was calling. His provider health system had sent him a text to do a virtual visit and you need an email address to register to do it. He never used email and we helped him set up an email account and walk him through how to do that virtual visit. We’ve had a number of stories since then, but it’s something that we’ve been proud of to help solve that digital divide.

Q. In the immediate wake of COVID-19, everybody saw a spike in virtual visits. But now all the data points to the fact that virtual visits are flattening out as patients start going back to clinics and hospitals and there’s a slight of pent-up demand. What are you seeing?

Josh: Something as an industry we have been able to demonstrate through the pandemic is that we can operate in a virtual fashion, but obviously not all care can be delivered virtually. But we have built that trust with our members and our patients, that there are effective ways to service those individuals virtually. And so, we are seeing that it is still running at high levels, but not as high as the peaks that we’ve had in pre-pandemic. So, as we start to open more, those numbers will continue to drop. But what we’re seeing and hearing from our member patient population is that they will continue to use virtual services for select interactions.

Q. Can you talk about your data and analytics program and how you’ve harnessed some of the social determinants of health?

Josh: Data and analytics is something that has always been one of the strengths for us. Under my purview, we manage the architecture, the data infrastructure, the tools and the healthcare informatics department. When you look at our role as a payer, we’re really a data aggregator where we’re getting all the data and we’re using that data to help influence care and help improve the service experience as well.

Also, we’ve got a centre of excellence that we run and enable all of our different business departments around the company and give them the tools to develop their own analytics. So, they can have data at their fingertips to make decisions and serve it up to the leaders in their departments. Also, more recently, we’ve moved into advanced analytics, leveraging AI, machine learning, where we’ve been selective on the use cases we target with AI. It takes more care and feeding as compared to traditional analytics. To make sure you’re focusing on the right use cases for AI and having the right processes in place, we need to be very focussed on our use cases to really improve our ability to leverage data and gain insights on data.

Social determinants of health have always been a priority focus of ours. So, starting out as a social HMO, we were really focused on SDOH. We use a bit of the external sources but have always maintained a good history of information and had the ability to collect that information directly from our members through a variety of means. We’ve been able to develop a pretty rich repository of SDOH data that we’ll leverage across the board. Those clinical models are very effective in looking at predicting some chronic conditions and potential clinical outcomes. We’ll be able to improve the care we deliver by using that data and then coupling it with the robust analytics program.

The last thing I would say on analytics is something we’re really focused on is real time analytics. But with the advancements of technologies, the replication technologies and with the CMS interoperability rule, we need to more tightly integrate with our provider network. This is because we are getting real time data straight from our health systems provider network. And we’re able to take that data and feed it across a rich and robust analytics program to really drive more outcomes as well.

Q. What is your advice to the tech firms and start-ups who are looking to be a part of your journey?

Josh: My advice to those start-ups and tech firms around is, make sure you’re building software that is aligned to your demographic population. As a Medicare Advantage CIO, I see it all the time that we present the software that is not geared towards the senior population. So, make sure you’re engaging that demographic using person-centred design, organising workshops with them, getting their feedback etc. Also, make sure you are building the software that’s going to be usable for them and is going to deliver outcomes.

The last thing I would say is, as a healthcare CIO, we’re all under attack from a cybersecurity standpoint. And even today, you still see a lack of adoption around information security. In the near future, if you’re not a high trust certified vendor, you’re going to have a tough time operating in the market. So, make sure you have a security focus as well.

Q. How did your consulting background prepare you for the CIO role? And what advice do you have for others in the consulting world who want to make a transition?

Josh: So, my background before becoming a CIO was exclusively working in the consulting industry. What really made me a well-rounded individual in my career is learning strategy work, which helped me understand how I need to develop strategies for organizations. Also, I learnt a sizable amount of system implementation work, leading a large system implementation and designing the operating model.

The thing that the consulting background really prepares you for is having that mindset of being able to design an operating model where you can put people in place to be successful and allow them to be able to execute on the strategies that you developed.