Meaningful Innovation
Sachin Jain, MD, MBA - Scan Health
“If you're trying to lead change for an organization, you have to go where the problems are. Jesse James said he robbed banks, because that's where the money was. If you want to be a change leader in healthcare, you have to go to where the problems are to actually create real change.” Sachin Jain, MD
Sachin Jain, MD MBA is the CEO of SCAN Health Plan. He won a Sharp Index Health Equity Award in 2021 for his leadership in improving health outcomes for underserved groups. Janae Sharp sat down with him at HealthIMPACT Spring to discuss innovation and leadership.
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Transcript:
Janae Sharp 00:05
Good morning. I'm Janae Sharp and I'm sitting down with Sachin Jain. Is that okay to call you that? Should I call you Dr. Jain? Good.
Sachin Jain MD MBA
Yeah.
Janae Sharp I wanted to talk to you about innovation, specifically, if healthcare innovation is real, how, how it's progressed in the past few years, and if it's in a bubble, we hear about it a lot in the space. So I wanted to hear your perspective.
Sachin Jain MD MBA 00:34
Well, you know, I, I believe that we have a healthcare innovation bubble, I think we have kind of the two different layers is what I kind of call them. One is, you know, kind of the reality layer. And then I would say, then there's like the cloud layer above the reality layer. And I think most of what people call innovation, healthcare resides within the cloud layer. And most of where healthcare is delivered is the reality layer. And I think it's always sobering for people who are working on the innovation side of healthcare, to actually seek it or need it. And then they realize how messed up it really is. I think one of the, one of the big problems is, healthcare is really a heavily networked delivery model. Meaning there are, you know, kind of strong ties between different unrelated entities, weak ties between unrelated entities. And you might be able to change one part of the equation, but then you almost always have to escape and go into some other part of the equation, which may be, you know, kind of stuck in a legacy world. And so I think that is the reason why healthcare innovation is as incremental and as modest as it is.
Janae Sharp 01:58
Yes. I think it's interesting what you were talking about, when you try to innovate for a specific problem? How have you, how have you done that in the past? How do you select your problems? How do you know, because there are tons of things to work on. So how do you focus on one thing,
Sachin Jain MD MBA 02:16
I think you got to look at the biggest pain points in your organization. So every organization I've been a part of, you know, there's the stuff people like talking about. And then there's the actual real world problems. And, you know, I'll just talk about some failures before I talk about some of the successes, because I think the failures are far more instructive. I joined Merck, as its chief medical information and Innovation Officer, in 2012, and I was essentially hired to solve a problem that the organization didn't really have. And what I mean by that is, is that, you know, Merck had a lot of, you know, I think things that needed to do, and improve its digital capabilities, was probably somewhere in, you know, the bottom 50 of all of the problems of the organization needed to solve at that particular moment in time. And so, you know, you create almost a target on yourself, when you come into an organization and you're focusing on a set of problems that most people feel are non core to the real problems. And so I think a big part of what one has to do when they're leading in an organization is choose the right set of problems to attack. And now I'll, if you'll let me, I'll share some success stories. I mean, when I was at Caremore, we identified member transportation as being a huge issue for us, in that we were eager to provide our members transportation, but many of the transportation vendors that we work with, didn't do a very good job delivering our members to their appointments on time. And so we were the first, you know, health plan entity in the country to actually partner with Lyft, or Uber. And we were able to dramatically improve service times as well as reduce costs, because it was a problem that was widely recognized in the organization. Similarly, you know, we built some of the first clinical interventions in the social isolation space when I was a kid and more. And again, it was something that people got excited about, and we're galvanized by, because it was a problem they were seeing every single day in their clinical practice. And so, you know, building a friendly color and friendly visitor program to address the needs of lonely older adults just made sense to people. Because again, it was a problem they were experiencing and seeing on behalf of their patients every single day, for which we had no solution. Now think about, you know, all of the innovations, so called innovation and digital startups that are kind of, you know, emerging in the healthcare industry. Many of them are solving problems that we don't really see as top of mind or top of the issue now that sometimes there's an issue related to problem definition. And whether we've done enough work to actually build a case around whether something is a problem or not. But if you're trying to change an organization, you have to go to where the problems are, you know, Jesse James said, you know, he robbed banks, because that's where the money was. If you want to be a change leader in healthcare, you have to go to where the problems are to actually create real change.
Janae Sharp 05:24
I wondered about that too, with things that I've worked on. Sometimes people aren't ready, like, we came into healthcare, talking about physician mental health, you know, two years before anyone seemed to care. And I'm interested in the idea that you go where the problems are, or right where people identify. However, our frame of reference as individuals isn't always spot on.
Sachin Jain MD MBA 05:59
I think that's so I think it's really important for someone who wants to be a change leader in healthcare to put themselves in a bucket, am I prompt in solving a problem that everyone recognizes? Or am I, someone who needs to now build the case for solving the problem? I know you've done amazing work and physician burnout, and are now kind of filling the huge need that people have identified coming out of the pandemic, I had a similar experience working on the on the issue of racism towards health care providers, which when I first published about it in 2013, in the Annals of Internal Medicine. First of all, I had received rejections from the New England Journal in JAMA because they said, you know, either they didn't like the way I wrote about it, or they didn't really see it as a problem. You know, fast forward, you know, nine years. And I think everyone recognizes that racism towards health care professionals is both, you know, an issue, as well as, you know, an abomination, frankly, that something that we need to correct. And so, again, you just have to make sure, you know, what phase of problem solving you're in? Are you in the build a story phase of problem solving? Or are you building a solution phase of problem solving, which I think are two frankly, very different phases and have different playbooks assigned to them? You know, I was a political science undergraduate. And there's a great literature on this stuff, actually, you know, on problem definition, you know, scholars like John Kingdon and Deborah Stone, you know, wrote about, you know, kind of the nature of how problems are both defined as well as solved. And, you know, the truth of the story is that how you define a problem ultimately influences how you solve the problem. And so those of us who want to create change has to really be thoughtful about how a problem is defined, because how that problem is defined, ultimately influences, you know, how it actually gets solved. Yes.
Janae Sharp 07:57
And the definitions, both for racism against physicians and providers and against mental health, like, those definitions are drastically different now than they were when you started. You did it before it was popular?
Sachin Jain MD MBA 08:12
Absolutely, absolutely. So
Janae Sharp 08:16
When people are coming to innovation or see a problem? Do you feel like there are tenants they should follow or a specific? No, like a code, like, it sounds like you have a very solid process. And I'm gonna copy it, and I'm going to have everyone else copy
Sachin Jain MD MBA 08:37
Well, you know, it starts with really not focusing a ton on who gets credit, I think that's where a lot of people go wrong. You know, a lot of times innovation is code for, I want credit for leading change in our organization. And I think if you're actually interested in the credit, there's one set of playbooks that you have to operate under, if you're interested in actually creating the change, then you have to make it, everyone's work. And you have to make it everyone's problem, which in some cases, means putting yourself in the background a little bit, and oftentimes organizing others to lead change, as opposed to you being the person who is driving the change yourself. And so, you know, I think about the old adage, you know, if you want to go slow, do it alone, if you want to go fast, do it with others. I mean, you really have to kind of, I think, find a way to, like, do it with others. I think that's an important part of an organization. A lot of people shy away from this, because they say I don't want to really get involved in organizational politics, but you have organizational politics as soon as you have more than one person in our organization. And so you just have to be really, really thoughtful about getting that piece of it right. I think, you know, the other piece of it is making sure that there's a real business model, and that it aligns to the business model that you're operating in. And it has to be material in the broader sense of the organization that you're out. gradients. So, so generic, you know, let's take burnout for a second, if you said, you know, let's help burnout for burnout sake, you might get a little bit of what we've gotten, which is yoga classes, you know, seminars, you know, issues, you know, meetings about the topic. And you might spend five years doing that, if you said, burnout was a driver of whether we can actually operate our organization, that burnout actually ties to
Janae Sharp 10:30
nurses, for example,
Sachin Jain MD MBA 10:32
burnout ties to turnover, turnover, returns to productivity, productivity loss leads to lost revenue, all of a sudden, you know, there's a, there's a different story around it. So I think it's again, building a case that ties to the thing that's important for the top level leadership of an organization. And then I think, you know, there's also just getting comfortable with a lot of trial and error, and recognizing the difference between healthy persistence and insanity. And, you know, and so, again, you have to be willing to kind of change our playbook, you know, from time to time. And oftentimes, we're not right. And so I think some of
Janae Sharp 11:16
there are some zealots, I might be one of them a little bit, it's like, no, we'll change the system to make it work.
Sachin Jain MD MBA 11:23
But a healthy dose of self reflection on what is needed in a particular situation, to drive change to lead change, I think is, is super important. And having a group of external advisors who can potentially even help you see your own blind spots is very, very important. And I'm always kind of leaning on my mentors, friends, my mentees from time to time to just get a different perspective on what I'm seeing play out, you know, organizationally or industry wide.
Janae Sharp 11:56
Yeah, being a leader who listens has a greater impact on your effectiveness. I wanted you to get credit, though, because you have done innovation, and done work in the equity space. Now you're continuing that work. And so I wanted to ask you, ask you a little bit about that, like when it comes to equity or accessibility? How did you, you know, what you tell us about what you've done and how that process worked?
Sachin Jain MD MBA 12:26
Well, we, you know, we focused on a big problem in our organization, which is different rates of medication adherence between our African American Latin ex members, and our Caucasian members. And, you know, we wanted to create change. And, you know, we suffer from all the issues that most healthcare organizations have, you know, we've got a long list of problems. You know, scan has a long list of issues that we want to address on behalf of our members. And, you know, healthcare disparities are but one of a number of different issues. So, in order to really create focus around it, we actually did what any rational group of people do, which is we put our money where our mouth is, we actually tied our annual incentive bonuses to whether we were actually able to close the gap. And I can tell you, you know, we spent the first six months of last year thinking that we were on the right track. And then when we looked at the data, we realized, like, oh, no, like, we are actually not, we're at risk of not closing this gap. And in fact, not at risk of not achieving a 10% portion of our annual bonus. And so that became very real very fast for our teams. And then, you know, all the kind of normal issues that organizations face, inadequate resourcing, you know, organizational sludge and politics, kind of all went out the window, because it was, we're all unified by both by this common purpose, and, you know, doing the right thing for the people that we serve, but also, the fact that, you know, we had our own skin in the game as far as actually solving this problem. And, you know, we saw as a result, real movement, and we were able to actually close the gap by about 35%. So it was very, very exciting.
Janae Sharp 14:08
That's good. Congratulations.
Sachin Jain MD MBA 14:10
Thank you very much. Thank you.
Janae Sharp 14:12
What do you think led to that? Do you feel like organizations can create that inflection point where they sort of, you know, throw out their ego and start getting to work?
Sachin Jain MD MBA 14:23
Yeah, I think it requires more leadership in healthcare organizations today. And I think we have a lot of people who think of themselves as leaders in healthcare, who are actually administrators. And they are, you know, people who kind of organize groups of people to do things. But sometimes, organizing people to do things also requires an element of revolutionary zeal. And it also requires a little bit of courage. And I sometimes have this question as I sit in different boardrooms, you know, that I'm a part of, and I think you know, would Gandhi and Martin Luther King have actually sat on a board. And if they didn't sit on a board, what would they look like? What would their conduct look like? And I'm sure they wouldn't be going along to get along. And I think a lot of people in so-called leadership positions in health care really go along to get along. They're more interested in survival, organizational perpetuation, self perpetuation, than they are unnecessarily creating real change. And that's a hard thing, to look at yourself in the mirror and realize about yourself. And I, it's a hard thing to say out loud about myself or other people. But at the end of the day, it's true, we sometimes aren't courageous, where we ought to be courageous. We aren't, you know, change oriented, where we need to be change oriented, we are going along to get along, we're saying the thing that the person in front of us wants to hear instead of saying the thing that they need to hear. And so I think we have an obligation as leaders in health care, people who have influence over people who take care of people to actually be focused on more of the right things and fewer of the wrong things, which sometimes means creating conflict, and sometimes means, you know, addressing uncomfortable truths about ourselves and our organizations. And that's a different way of looking at it that I think most people think about their roles, which is oftentimes to just follow the leader follow what's fine, what, what they're what they're supposed to follow, not recognizing that there, they're out there, you know, they may or may not be participating in some ways, you know, in their own kind of moral injury. Because they aren't necessarily doing the thing that they need to do to create the change that needs to be created.
Janae Sharp 16:45
Yeah, I know, for me recently, I had an experience where someone told me: well, that kind of makes you look weak. I replied: Well, I am weak here, this is beyond my capacity. And it was really eye opening to see what happened when I asked people for help from our board and advisory board, and it went really, really well. But it was also intensely uncomfortable to just be like, well, this is just not something I'm going to do. I wonder how health systems work? How do you as a leader deal with that? Are there situations where you've had to be like, this is a no for me?
Sachin Jain MD MBA 17:27
No, it's the kind of thing that causes me to lose sleep, you know, frankly, is, you know, making sure I'm being fair, fair to myself or to my organization. Fair to my leaders. So that's, that's, that's the work that we have to do.
Janae Sharp 17:40
I'd love to hear a lot of people have questions about the payer space, co creating something with a health care delivery system, sometimes it seems like two separate worlds that never cross paths, especially if you're in the healthcare system, trying to find out if you're covered. How have you worked with systems? Or how have you brought those different people that you mentioned together?
Sachin Jain MD MBA 18:12
You know, I think a lot of it has to do with finding common pain points and, you know, common problem areas. And I think we're all struggling in a competitive environment for growth. We're all struggling to create differentiation that makes us more attractive to different populations, something I'm actively exploring with health systems is, you know, taking a look at specific ethnic populations in Southern California, the Korean population, the Vietnamese population, who have long been underserved by traditional health care providers, and asking how do we create an end to end experience, both from a health plan as well as a healthcare delivery perspective, that creates, you know, meaningful change in value for patients? So it's those types of things?
Jnae Sharp 18:54
Yeah. Well, thank you. I didn't know if you had anything else you wanted to share. I I love your work. And I'm really glad that you were able to come and share some of that with our audience.
Sachin Jain MD MBA 19:06
Well, there's a lot of mutual admiration, I think your work on burnout, as we talked about, was kind of before its time. It's kind of everyone's favorite topic these days. And I, but I think it's, you know, something, I think what, what is most important is, is that we create a set of problems that, you know, regardless of where you sit, what role you're in, whether you're in the health plan side, nonprofit side, the for profit side, you know, is is important. We have a lot of those problems in healthcare like that are problems that are cross cutting, like burnout. So, to go back to your original question, you know, how do you create change? It's really about, you know, figuring out what that burning issue is, and then drawing the lines between that issue and the relevance. I think you've just done an amazing job of that. So grateful to be on this journey with you.
To learn more about Sachin Jain MD MBA and his work in improving healthcare, follow his column on Forbes.
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