There are nearly 4,000 Medicare Advantage plans for older adults to choose from nationwide for 2024, and payers are launching unique benefits aimed at serving specific and segmented populations.
One of those payers is SCAN Health Plan, which boasts the country's first Medicare plans built around the needs of older adults who are women or part of the LGBTQ+ community. Becker's sat down with SCAN Group CEO Sachin Jain, MD, to discuss how these plans are developed and the business case for why other insurers should do the same in an increasingly competitive Medicare Advantage market.
Question: SCAN Health Plan has launched Medicare Advantage plans specifically built for the LBGTQ+ community and women, along with a 10-year partnership with ApolloMed to provide care to Asian and Hispanic populations. What is the strategy behind population-specific MA plans?
Dr. Sachin Jain: If you're really going to be an organization that tries to meet the needs of seniors, and we are, then your mission is to keep all seniors healthy and independent. That means sometimes customizing your offerings to meet the needs of specific populations.
We launched the LGBTQ plan, Affirm, out of recognition that many people in an older demographic came of age and came out at a time where they unfortunately lived with a lot of shame, ostracization and stigma. When you think about reasons that people don't access healthcare, some of it is related to specific issues around identity. We thought we would have no more than maybe 200 members enrolling max, but by the end of last year we had over 600. During this enrollment period, we're expanding the plan into San Francisco County. We're very excited and are hoping that we'll end with more than 1,000 members by the end of this enrollment period.
When we started to see the commercial success of the Affirm product, it forced us to start asking about other seniors whose healthcare needs are not necessarily being met by the dominant plan offerings. When we looked around the marketplace we realized that there wasn't a single MA plan in the country that actually focuses on the specific healthcare needs of women. Women are at the center of their family's healthcare journeys and have needs both as healthcare recipients, but also as caregivers to their parents, children and grandchildren. I challenged many of the women in leadership at our company to build a plan that they would want when aging into Medicare, and that was the genesis of what we call our Inspired plan. What's been exciting about that is we've been able to enlist a number of world-class provider groups to be partners with us in Southern California to create a really customized experience for older adult women. At the heart of this offering is a health navigator who can help women that are busy juggling so many other things. What we find with a lot of women is that because they're so focused on caring for others, they often neglect their own needs. We're here to provide that extra level of support.
Q: How do you figure out which benefits are going to be most beneficial for a specific population?
SJ: The short answer is that we don't, though we do some testing with our members. Some members actually work with the plan as peer advocates to provide input into plan benefit design. But we're approaching specialized plans quite humbly. Part of what we're going to be doing is asking our members what services are most valuable as they enroll in a plan. Year one is about getting the membership and year two is about working collaboratively with members to really understand what their needs are. With Affirm, we're working with an external market research firm to study our own population and understand why they chose the plan and how we can make it even more valuable for them. Over time, we expect this is going to generate a lot of word of mouth. The most powerful growth lever is peer-to-peer referencing, so that's what we're trying to unlock.
Q: What is the broader industry trend around segmented Medicare Advantage plans? Do you expect these to continue to grow in popularity?
SJ: There's a service aspect here of wanting to provide specialized services. The other piece, from a candid business perspective, is companies want to unlock different vehicles and vectors of growth. Medicare Advantage is a commodity market in many regions, with companies marketing the same network or the same benefits. If you're running a plan these days, part of what you're trying to do is figure out how you can capture more people that you previously didn't necessarily feel were aligned with your plan. I think the mandate for anyone who's leading a health plan these days is to really drive meaningful differentiation that actually serves patients.