In this debut episode of Quality Talks With Peggy O’Kane, Founder and President of NCQA, Peggy is joined by Dr. Sachin Jain, CEO of SCAN Group and SCAN Health Plan, to explore a provocative question: Why isn’t health care better at getting better?

• Measuring—Not Missing—What Matters: Anxieties about access and affordability plague everyday people. But quality measurement’s focus is elsewhere. Is health care chasing the wrong metrics and missing the big picture?

• The Complacency Crisis: Sachin says the core issue is a reluctance to embrace real reform, noting the industry’s tendency to want improvement without being willing to change fundamental practices. He calls for a bolder approach.

• Rethinking Medicare & Medicare Advantage: Sachin challenges rosy view of traditional Medicare, and describes how a legal battle over a flawed Medicare Advantage star rating raised questions about how measuring quality affects care.

• Simplifying for Impact: Sachin proposes focusing on three or four areas, emphasizing patient experience, ease of access and basic care for common conditions. He urges cost transparency, simpler administrative processes and renewed competition.

Key Quote:

“ If we all just took care of our own part of the ecosystem, we'd get 20, 30% better. But instead, the most industry talking points are about, ‘Hey, we don't get paid enough for what we do.’ Everyone who's making money claims that they're losing money on X, Y, or Z lines of business. Everyone complains about regulatory capture, so there's just a bit of having normalized the abnormal. And I think that that's the thing we have to undo if we're going to actually make the kinds of forward progress that we're hoping to make as an industry.”

-Sachin Jain, MD

Time Stamps:

• (01:44) Inspired by Our Mentors in Health Care
• (04:27) How Does Health Care Get Better?
• (7:28) The Trap of Toxic Positivity 
• (11:34) Misplaced Nostalgia for Traditional Medicare
• (18:05) The Stars Program Controversy
• (22:13) Simplifying Health Care Measurement

Links:

Connect with Sachin 

Learn More About SCAN

Connect with Peggy

Learn More About NCQA