Coming off our 40th anniversary in 2017, we spent 2018 deep in strategic planning. While change has been a constant for us over the years, the changes in the healthcare industry today are happening rapidly. We took a detailed and thoughtful look at the environment, our constituents, our industry, the data and more to determine our future course.
Keeping seniors healthy and independent continues to be our mission. And, years after we sunset the Social HMO, we continue to focus on high-needs seniors: those with multiple health issues and/or challenges that impact their ability to access care or manage their health. Social Determinants of Health (SDOH) is the topic these days, but it’s nothing new to us. The Social HMO was designed to address SDOH. That’s our wheelhouse. These are our people.
By 2023, 800,000 Californians in our current service areas will become newly eligible for Medicare. We’re here for them with the products and services that will enable them to continue leading healthy, active lives. But the fastest-growing age segment is 75 to 79—the transition age, when many of us begin to experience health changes and need more from the healthcare system. We’re here for them, too, with our care management expertise and in-home benefits.
Our long history as a Social HMO used to be an interesting side note. But it’s proving its value. We understand the challenges members face as they journey through these years. We know how to help them along the way. I can confidently speak on behalf of the 1,200-plus SCAN employees when I say it is our great honor to do so.
I’ve had the pleasure of leading SCAN since 2011. I’ve always said that our goal is not to be the biggest health plan. Instead, we want to be the best at serving seniors, be they our members or those in the community. These pages highlight some of our efforts in 2018. I encourage you to read, and invite your feedback and participation.
CEO, SCAN Health Plan
Our greatest achievements are the ones that confirm we’re doing a good job for our members and the seniors we serve.
CMS 4.5 Star Rating
In October, we learned that we once again earned 4.5 Stars in Medicare’s 5-Star quality rating system.*
*Star rating applies to all plans offered by SCAN Health Plan® except SCAN Healthy at Home and VillageHealth. Star ratings are calculated each year and may change from one year to the next.
Source: 2018 CAHPS Rating of Health Plan, as reported in 2019 Medicare & You
4.16 / 5
The results of our annual employee engagement survey put us in the 86th percentile of all Gallup clients.
We’re proud that of the 12 statements the survey measures, our highest response (4.47 / 5) was to this statement:
“The mission or purpose of my company makes me feel my job is important.”
We appreciate external validation of our efforts and were honored to have been recognized with the following awards in 2018.
Best in Biz
Nonprofit Organization of the Year
U.S. News and World Report
Best Insurance Companies for Medicare Advantage 2019
STEVIE® Silver American Business Award
Management Team of the Year
STEVIE® Bronze Sales & Customer Service Award
Customer Service Department of the Year
STEVIE® Bronze American Business Award
Customer Service Department of the Year
Customer Service Executive of the Year
Best Medium Contact Center
Aster Awards, Healthcare Advertising Awards, and The Telly Awards
Recognition for our communication efforts
In addition to star ratings and member satisfaction, we also look at membership growth and member retention as key success factors.
3rd largest in the nation
2nd largest in California
Among not-for-profit Medicare Advantage Prescription Drug Plans (MAPDs)
2018 year-end membership
gained during AEP
(October - December 2018)
as of May 2019
As we pass the 200,000 member milestone, it becomes even more important for us to improve how we interact with our members. Healthcare is personal. And while we’re typically a step removed from their healthcare experience, they depend on us to support them along the way. Adding strategic use of technology to the human touch we’re known for enables us to build and retain relationships with our growing membership.
Improving How We Connect
As we learn from our members every day, seniors are a diverse group. We hear from those who are still gainfully employed in a career as well as those who’ve embraced retirement and even some who’ve turned a hobby into a job (hello, 71-year-old ski instructor!). Of course, their health needs are as different as they are. For many of our members, the preventive benefits and gym membership SCAN offers are exactly what they’re looking for. For members facing health challenges, however, SCAN provides more intensive benefits and services (read more). The key is identifying where each member is at and what they may need. And that was one of our focus areas for 2018.
Affordable Access to Care
Regardless of health status, all members benefit from affordable access to care. That’s why in 2019 the vast majority of SCAN members have these $0 copays:
PCP office visit
Tier 1 drugs
Tier 1 and Tier 2 drugs by mail-order
99%of SCAN members also have access to these extra benefits:
Hearing aid benefit
Engaging on a Personal Level
SCAN is known for our personal touch. We call each new member to welcome them to the plan. And many members tell us they count on—and look forward to—their birthday call every year. We’ve built on these touches over the years. In some cases we use technology in place of an in-person event, enabling us to reach thousands of members throughout our service areas with a single “Straight TeleTalk” interactive conference call, for example.
But technology won’t replace one-on-one and in-person engagements. There’s something about connecting at an individual level that members and employees, from our senior executives to our front-line staff, all appreciate.
100+ Club Grows
When making birthday calls a few years ago, the Senior Advocates noticed a trend: they found themselves saying “Happy 100th” to more and more SCAN members. They thought this milestone deserved more than a phone call. That was the start of the 100+ Club.
Centenarians receive a personal letter from CEO Chris Wing and, whenever possible, the Advocates arrange for a birthday visit. They bring balloons and a cake large enough to feed whoever else the member wants to invite. Sometimes there are friends, family members or fellow residents joining. Other times it’s a more intimate visit, allowing our team the honor of celebrating these inspirational members.
Centenarians in 2018
100+ Club visits
Age of oldest SCAN member in 2018
Age of oldest members visited (two of them!)
Our members have such wonderful experiences and stories to share. The perspective they have is really something amazing and we all come away from these birthday visits so moved and inspired.”
—Pam Bailie, Senior Advocate
The Member2Member program draws on the power of peer counseling to address the common issues of aging. Like the Senior Advocates, Peer Advocates are SCAN members who work part-time, connecting with members. Peer Advocates, however, specifically discuss those issues that many find hard to talk about—even with their doctors. Having a fellow senior call and bring up the issue, sharing tips, sending information, even commiserating and sharing personal experience often makes the difference.
10 Peer Advocates
3,629 Member2Member participants
Issues discussed: depression, physical activity, urinary incontinence, falls and pain
I want to thank you for the resistance bands you sent me. You talked me into getting back to exercise. It’s always a pleasure to speak to someone that talks to you with dignity and respect.”
—74-year-old SCAN member, Costa Mesa, CA
The physicians and office staff that interact with and care for our members are often the face of SCAN to our members. When we’re rated on the quality of care members receive, or members respond to survey questions asking whether their care was well-coordinated or the office wait time was under 15 minutes, they’re reporting on their experience at the doctor’s office—not with SCAN. We understand there’s a tension between caring for the patient and meeting the demands of a heavily regulated industry. That’s why we’re investing in pilots and programs that will allow providers to do what they do even better.
Engaging, Collaborating, Sharing
Several years ago we invited leaders from our key provider groups to form a Provider Integration collaborative. The 5-Star quality rating system was still relatively new and we thought it would be a good way for all of us to become familiar with the system, discuss the implications and asks on all of us and, ultimately, improve the quality of care seniors receive.
Since then, it’s become a true collaboration. We share performance data so groups see how they compare with their peers. Those who perform well in an area share their best practices. Providers have a direct line to SCAN, sharing concerns, challenges and opportunities. It’s been the sounding board for many of our programs and innovations as well, including SCAN’s Office Staff Training (OST) and Connecting Provider to Home (read more). This is our way of building in “systemness,” which enables us to ensure seamless, high-quality care is delivered consistently across the network.
SCAN’s 4.5 Star rating is not only a reflection of our efforts to improve quality and service, but an investment that pays off in a meaningful way for us, our provider partners, and our members.
Office Staff Training (OST) Grows by Popular Demand
Launched in 2016 to help standardize service quality across our network, OST offers a number of mix-and-match courses to medical groups. SCAN trainers travel throughout our Southern California service area to deliver on-site trainings, usually bringing lunch as well.
To help respond to the training demand, we now hold annual Train the Trainer events, arming staff management with the insight and tools they need to provide and/or reinforce the OST courses.
2018 Office Staff Training Results:
4,106 Office staff members participated
541 Physicians participated
21 Courses offered
Most requested courses:
Trading Ages (senior sensitivity)
CLEAR/HEAT (customer service)
137 Train the Trainer participants
24 Groups represented
This was my very first training and I can gladly say it was very informative. Thank you for the opportunity, and I look forward to more trainings like these.”
Quality Program: Ongoing Commitment
Underlying all our efforts is a focus on quality that encompasses the 5-Star efforts, our work to ensure health equity, address Social Determinants of Health, and continually improve member service. It comes down to the quadruple aim: patient experience, population health, reducing costs for individuals and the system, and care team well-being. And it will take all of us—plans, providers, policymakers and local government and community organizations—working together to deliver on the commitment.
We’ve long advocated for programs and policies that would enable us to deliver the types of benefits and services seniors need to stay healthy and independent. To that end, 2018 was a very good year for Medicare beneficiaries.
New Laws, New Opportunities
Medicare Advantage (MA) plans have proven to provide high-quality, value-driven and cost-effective care—and that hasn’t been lost on lawmakers. At the federal level, MA plans have earned bi-partisan support, with more than 360 members of Congress pledging in 2018 to preserve the program. They showed their support in more tangible ways with legislation that has made it possible for plans to further improve services and health outcomes.
The definition of “primarily health-related” supplemental benefits was expanded in 2018 to allow MA plans to offer food, counseling and other non-medical services as long as they can help prevent, cure or reduce illness or injury.
MA plans are now allowed to tailor benefits to groups within their membership, rather than offering the same benefits to all enrollees. For example, all members with diabetes within a plan could receive additional podiatry coverage.
Telehealth services can be included in a plan’s basic benefits. We see great opportunity for this technology in the delivery of mental health services and for post-discharge follow-up.
Special Needs Plans, which were temporary demonstration projects, can now be offered by MA plans on a permanent basis. This provides stability for the plans offering these products and reassurance to plan members.
Based in Washington, DC, Adrienne Morrell joined SCAN in 2018 as Senior Vice President, Public, Community and Government Affairs. Adrienne and team focus on educating legislators on the value of Medicare Advantage and Special Needs Plans and ensuring we have a voice on important issues and decisions impacting the seniors we serve.
SCAN Benefits in 2019
So did these 2018 changes have much impact on 2019 benefits? It takes time to design and implement new services, after all. But because SCAN already offered many of these types of benefits through our Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP), we were able to incorporate them into many of our other products fairly easily.
SCAN Home Advantage
This home safety evaluation benefit includes an assessment, safety plan, and access to a SCAN care navigator at no cost. We will also provide connections to resources to help make any modifications needed.
SCAN Returning to Home
A post-hospitalization benefit, members (and their caregivers) receive in-home support and services, including meals and help with bathing, dressing and medication management—all at no cost.
These virtual appointments are a good option to an urgent care visit.
We’ve seen the value of offering, arranging and providing for Social Determinants of Health for years, and we really applaud the decision from CMS to give plans the flexibility to offer these types of non-Medicare services that plans like SCAN know will improve the quality and experience for the patient and family and at the same time reduce costs.”
—SCAN CEO Chris Wing, AIS Health, January, 2019
Keeping seniors healthy and independent is not just the health plan’s mission, it’s our overall imperative. SCAN’s community services enable us to connect and engage with seniors and caregivers in the community and to support other organizations that do the same.
Facts and Figures
Total amount SCAN spent on community services in 2018, including Independence at Home (IAH) and other community programs
16,821 Clients served in IAH via government programs, direct services, resource navigation and community education
855 Community education events
Resource navigation is an art. Many of the people who call the IAH toll-free number don’t know where to turn. Our resource navigators listen and assess. If community connections are all that’s needed, we don’t just provide a phone number and call it case closed. We let the client know who to call, what to ask for and how to explain their request. And we’re always here for assistance along the way.
I liked the warmth with which they help solve your problem, giving you options and making you feel that they are on your side.”
6,887 Volunteer hours
474 Community events
2,198 Thanksgiving meals delivered
676 Thanksgiving volunteers
SCAN started working with social media influencer Jorge Narvaez of RealityChangers last year and thought the perfect way for him to get to know us was to invite him to our annual Thanksgiving meal delivery. Not only did Jorge deliver a meal, he brought his whole family along (pictured below). Despite the early start, all five worked enthusiastically alongside our volunteers, packaging meals and loading up cars.
48 Presentations to such diverse groups as:
Gerontology students at Long Beach State University
Architecture and gerontology students at University of Southern California
Maintenance crews and resident service coordinators at senior housing facilities
I loved this. Empathy is what is needed every day no matter what your age.”
—Trading Ages participant
Coming Soon: Trading Ages – Virtual Reality
As effective as our traditional Trading Ages workshop has been over the years, we knew the right technology could really bring the experience of aging to life. And it has. Using virtual reality to simulate three common experiences of aging has taken Trading Ages from interactive to immersive. Early response has been enthusiastic and, in some cases, emotional. That’s exactly the impact we were looking for.
SCAN Community Giving focuses on extending the safety net for our most vulnerable citizens. We place a heavy emphasis on support organizations that help older adults meet their most basic needs of food, housing and health.
$777,650 Total grants and sponsorships
$220,000 Senior Support Services grants
$70,000 Emergency Assistance grants
$200,000 Nutrition grants
$257,650 Donations and sponsorships
$30,000 Emergency Assistance – wildfire areas
Many of the programs we’ve developed are a direct result of needs our staff have identified when they are in the clients' homes. Others are a collaboration with the health plan to pilot a service we think will benefit seniors and caregivers at large.
American Geriatrics Society Annual Scientific Meeting
American Society of Consultant Pharmacists Annual Meeting
Gerontological Society of America Annual Scientific Meeting
American Society on Aging Aging in America Conference
California Association of Long Term Care Medicine Annual Meeting
LeadingAge Annual Meeting
We’re firm believers in sharing our findings, so we proactively look for opportunities to share program results and related information. We hope other organizations can leverage what we have learned to enhance services and support for seniors in other regions.”
—SCAN Chief Medical Officer Dr. Romilla Batra, Aging Today, July/August 2018
Insights: Behavioral Health Services
362 Clients served | English, Spanish, Korean and Vietnamese
Our unique approach to behavioral health services brings a licensed therapist to the client’s home to manage depression, anxiety and caregiver strain. The results, based on clinical screening tools, are insightful:
Depression and anxiety levels dropped from moderate to mild
Caregiver strain levels dropped by half
Bringing a Lifetime of Insight
After retiring from the airline industry at the age of 64, Haig Barsegian went back to school for his master’s degree in clinical psychology. He worked for eight years counseling homeless seniors before joining SCAN. At the age of 81, he works as a therapist for the Insights program.
Don’t just limit yourself because of the calendar. Be thankful for what you have today and reminisce about the good times.”
—Haig Barsegian, Insights therapist
C-MEDS: Medication Safety
After seeing too many clients struggling and failing to adhere to complicated medication regimens, the IAH team developed the Community Medication Education Data & Safety (C-MEDS) program.
170 Older adults | English and Spanish
The goal is to ensure clients understand the importance of their medications and help simplify regimens; enabling them to more easily manage multiple meds, leading to better health outcomes.
Adherence rates improved from 40% to 73.45%
Risk of non-adherence dropped from 4.7 to 1.9 (<2 is goal)
The people helping me really care and listened to what I had to say. I felt actually loved.”
Connecting Provider to Home (CP2H)
704 Seniors served, and counting
7 Participating provider groups
Rosaneli Loza was a SCAN case manager when she identified the issue: Many of the already frail members she worked with didn’t understand or couldn’t follow their doctor’s instructions, putting their health and independence at risk. Rosaneli also had a solution: bridge the gap by deploying a community health worker and social worker team to assess the patient’s home environment and accompany the patient to doctor visits.
Team members communicate challenges and updates to the doctor and then help the patient incorporate treatment directions into their daily lives. The results have been life-changing for the patients, and measurable for the provider groups.
Among program participants:
Inpatient hospitalizations: reduced by two-thirds
ER visits: reduced by half
Rosaneli is now manager of the CP2H program, overseeing the teams in the field. Teams are provider group-based and participating seniors are identified by their doctors. SCAN membership is not required.
The [CP2H team] has done a great job with very difficult patients.”
—Physician assistant, AppleCare Medical Group
Time Off to Volunteer
Many SCAN employees are loyal community volunteers on their own time. With Volunteer Time Off (VTO), we encourage them to take part in Volunteer Action for Aging opportunities that may take place during regular work hours. Some departments volunteer together, using it as a team-building opportunity. Our IT team has led cyber security classes, for example, and Healthcare Services staff helped plant a senior community garden.
Even with my limited knowledge of technology, I was able to help seniors with their basic questions about adding contacts and texting. It was an empowering afternoon that made me grateful for the ability to keep in touch, and the ability to share that skill with seniors to keep them socially engaged.”
—Keya Smith, Pharmacy & Health Education Coordinator, Technology Connection Volunteer (pictured on left)