Sachin Jain, MD, MBA, FACP, president and CEO at SCAN Group and SCAN Health Plan, discusses how data can help ensure that vulnerable populations aren't harmed by value-based payment models.
Sachin Jain, MD, MBA, FACP, is the president and CEO at SCAN Group and SCAN Health Plan.
Transcript:
The paper you co-authored discussed the need to ensure that value-based payment models do not create incentives that work against vulnerable populations. How can data help overcome this problem?
Jain: Yeah. Ultimately, at the foundation of this concern is risk adjustment. I think there's always an unintended consequence when you introduce a payment model that rewards organizations for managing health care utilization, there's always a risk that organizations will selectively apply those payment models to certain populations, unless, of course, they're rewarded for actually taking on that higher degree of complexity. Of course, it's very hard to identify that complexity, oftentimes, when we don't actually have the data that you need to have to appropriately risk adjust or identify cohorts of populations that could benefit from more intensive services and that warrant higher levels of reimbursement. With a better core of data, there's opportunities to, I think, create a higher degree of specificity around who actually exists within a population, and then pay organizations accordingly.
I think one of the areas where we've seen real challenges with this is actually the Medicare Advantage star rating system, where you're rewarded for completing a number of preventative screenings on patients as well as providing certain patient experience levels. Ultimately, some populations are harder to serve than others, but there's not a lot of adjustment for that in the formulas that calculate those star ratings. So, while the star ratings are directionally fantastic and are appropriate, they introduce this challenge of potentially rewarding organizations for actually serving healthier populations. Again, I think we have an opportunity to do better and a better core of data could actually help us do that.
Bridging the Gaps: New Strategies for Preventing Cardiovascular Disease
July 31st 2025During the Addressing Cardiovascular Risk and Intervening Early webinar, experts discuss innovative strategies for cardiovascular disease prevention, emphasizing risk assessment, lifestyle changes, and collaborative care to improve patient outcomes.
Read More
Taletrectinib Recommended in NCCN Guidelines for ROS1-Positive NSCLC
July 31st 2025Taletrectinib was added to the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology as a preferred option for the first-line and subsequent treatment of advanced ROS1-positive non–small cell lung cancer (NSCLC).
Read More
Trends in Insulin Out-of-Pocket Costs and Use Disparities, 2008-2021
July 31st 2025Given trends in cost and use, insulin out-of-pocket cost reduction policies would be more efficient if they targeted members in high-deductible health plans with savings options and low-income patients.
Read More
Linvoseltamab Added as Preferred Agent in Newest MM Practice Guidelines
July 31st 2025On July 2, linvoseltamab-gcpt (Lynozyfic; Regeneron) received an accelerated approval from the FDA in relapsed/refractory multiple myeloma (MM), and the most recent update to the National Comprehensive Cancer Network guidelines for MM has added the BCMA-targeted bispecific antibody as a preferred treatment option.
Read More