SCAN Health Plan and ApolloMed are forming a 10-year value-based care partnership, the organizations told MedCity News exclusively this week. In addition, SCAN is launching a Medicare Advantage plan designed for women.
SCAN Health Plan is a Medicare Advantage insurer serving people in California, Arizona, Nevada and Texas. Alhambra, California-based ApolloMed offers a healthcare delivery platform that helps providers engage in value-based care. Its physician network consists of more than 12,000 contracted healthcare providers — including primary care physicians, specialists and hospitals — and serves patients across 20 states and territories.
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The partnership creates a health plan called Compass, which is a Provider Specific Plan (PSP) offered through SCAN. This means that Compass members will exclusively be members of ApolloMed’s network of physicians, including its specialists in cardiology, OB-GYN, outpatient behavioral health, outpatient substance use and other areas.
“We’re addressing some of what I think people find challenging about Medicare Advantage, which is access to specialists,” said Dr. Sachin Jain, CEO of SCAN, in an interview. “This product includes the ability for members to self-refer for a first visit to popular specialties like cardiology, dermatology and behavioral health.”
The agreement is a full-risk value-based arrangement that is tied to patient experience, preventive health screenings, adherence to medications and other outcomes, Jain said. The Compass plan will be offered to those in California’s Los Angeles, Riverside and San Bernardino counties.
Part of why SCAN chose to partner with ApolloMed is because of its focus on underserved communities: 70% of ApolloMed’s patients are Asian, Hispanic or African American, Jain added.
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“We wanted to make a deeper commitment to these communities and launch products that differentially serve diverse populations with benefits that are co-designed between the health plan and the provider groups because oftentimes, health plans and provider groups are working at odds with each other,” he said.
SCAN’s focus on diverse communities is also why ApolloMed chose the insurer as a partner, said Brandon Sim, Co-CEO of ApolloMed.
“In SCAN, we have found a partner who understands as much as we do that healthcare is local, and that healthcare must be tailored to diverse and traditionally underserved populations,” Sim said in an email. “SCAN’s focus on historically marginalized communities is the exact mission that ApolloMed was founded to address, and we view SCAN as a partner that can work with us to deliver exceptional healthcare to not only the communities we’re based in today but also new regions as we grow together.”
In addition to the partnership with ApolloMed, SCAN announced it is launching what it claims to be the first women-focused MA plan called SCAN Inspired (though men can still enroll if they’d like). The plan will be offered to those in California’s Orange and Los Angeles counties and is in partnership with Cedars Sinai.
Inspired will connect members with their own women’s health advocate, a healthcare professional who can assist members in receiving personalized care. The plan will also offer $0 estrogen therapy, access to fitness facilities and on-demand live streaming fitness; reimbursement for weight management programs; and other benefits.
“Everyone needs support identifying where to go for care, almost everyone needs someone’s help actually getting access to care,” Jain said. “What we want to do is provide that concierge-level service to busy, active women aging into Medicare.”
The launch of Inspired comes a year after SCAN launched SCAN Affirm, an MA plan geared toward LGBTQ+ older adults. Jain said the insurer plans to continue to create community-specific MA plans, but declined to say what kinds.
“I think for too long, we’ve kind of shrugged our shoulders and said, ‘Everyone should eat wonder bread.’ What we’re saying now is, ‘If you want to eat cinnamon raisin, you want to have whole wheat, you want to have whole wheat with sesame, pumpernickel, whatever it is, we’re going to have something for you,’” Jain said. “Medicare Advantage does offer this opportunity around community customization, partnerships, differentiated benefits, and is oftentimes a missing part when people do their fee-for-service versus Medicare Advantage comparisons.”
Photo: metamorworks, Getty Images
