One health insurance CEO on why radical common sense can save America’s broken healthcare system

In a recent episode of Lifers, we spoke with Dr. Sachin Jain, the president and CEO of SCAN Group and SCAN Health Plan, which serves more than 300,000 members across the U.S.

Jain, who has more LinkedIn followers than nearly any other healthcare executive, is candid on social media about the flaws of the healthcare system.

“We normalize the abnormal. And I think the work that we have to do in healthcare is to stop normalizing abnormal things,” says Jain, who also served as a chief medical information and innovation officer at Merck and a senior advisor to the Obama Administration.

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Jain champions one core principle as the missing piece that could transform the American healthcare system: radical common sense.

“Common sense is not given enough credit or value in an ecosystem that really values innovation,” he tells us. “Sometimes, common sense is innovation. And I don't know that we necessarily view it as such.”

For one, as the previous CEO of CareMore Health and Aspire Health, Jain deployed radical common sense when implementing non-emergency medical transportation. “When other health plans were kind of continuing to partner with the existing vendors, we just said, 'Why don't we partner with Uber or Lyft?’” he says, adding it helped improve no-show rates and patient satisfaction.

When Jain thinks about the transformative effect radical common sense can have on the healthcare system, he thinks of his Dad.

“I lost my father a couple of years ago. He was a diabetic, diagnosed when he was 40 years old. He had intensive interventions between the ages of 40 and 50,” Jain says. “He might still be sitting here today. Instead, he died on dialysis after a hip fracture.”

In the episode, Jain touches on the power of radical common sense, his take on the growing concierge medicine ecosystem, the future of primary care, and more.

The ‘truth-telling problem’ in U.S. healthcare

Jain says too many people in healthcare have accepted the status quo, and that is true on both sides (payers and providers).

“Lots of healthcare organizations really operate like they're law firms that happen to deliver a healthcare product or healthcare services,” he says. “Part of what we're talking about here is the broken culture of leadership in healthcare, which sometimes ends up being more about compliance with rules than it is about actually doing the right thing.”

Instead of accepting reality, Jain says true healthcare innovation begins with believing the status quo can be changed and with developing a plan of action to tackle common problems.

“We're the only health insurance company in our industry that has gone out and said what almost every single American feels, which is that our industry is broken,” Jain says. “One of my fundamental values is you can't fix things unless you actually say that they're broken because you're never going to get to the underlying truth of the issue if you're kind of hiding behind toxic positivity … we have a truth-telling problem in US healthcare.”

The rise of DIY healthcare

The longevity care and concierge medicine ecosystem has grown dramatically, largely in step with the growing distrust and frustration with traditional services. However, the worry is that these places are not built on sound science, nor are consumers equipped to know what to do with more data, Jain says.

“The American public at large, without a real clinical education and without anyone to adjudicate this information for them, is really left to figure it out for themselves. And that's a really dangerous place to be,” Jain says. “I don't think we should really be turning into a nation of healthcare consumers.”

While companies like Prenuvo, which offer $2,500 full-body MRIs, have been gaining popularity, Jain says more testing is not always the answer. And that’s especially true if it leaves people more overwhelmed and less informed about their options.

“Right now, if I'm going to a direct-to-consumer MRI and then I find something and I don't have someone trusted to really process that finding with me, then I'm actually just creating an epidemic of medical anxiety in this country,” he says.

The answer? Turning back to primary care and implementing radical common sense.

“We should give people a primary care physician or a guide who's going to help them navigate all of this because there's only going to be more of it going forward,” he says

A nod of optimism

Despite everything that’s going wrong, Jain is seeing more people in healthcare at their wits' end — which he says is promising. It can also be the door to implementing more radical common sense. There’s only so much worse it can get before it gets better.

“I see doctors getting really mad, patients getting really mad, and I see alternatives that are kind of popping up to really address the pain and frustration that people are feeling,” Jain says.

“This is where the innovation economy is actually going to serve healthcare really well … the disruptors are going to actually force the incumbents to act differently.”

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Lifers Podcast features Christina Farr, CEO of Second Opinion Media and a former CNBC journalist and healthcare investor, in candid conversations with healthcare founders and CEOs building for the long term. Focused on real-world strategy, regulation, and innovation, it offers a no-hype look at what it actually takes to succeed in the $4 trillion healthcare industry.

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