SCAN: Sachin Jain

“Just dive in and try to solve problems.”

At the helm of a large healthcare company, with deep ties to academic medicine, government and industry, Dr. Sachin Jain is not an obvious “outsider.” Labeled one of Modern Healthcare’s 100 Most Influential in 2023, Jain was faculty at Harvard Business School, an attending physician at Harvard Med, and an executive at Merck and Anthem, prior to his current role as CEO of the SCAN Group and SCAN Health Plan.

On accolades alone, one might expect Jain to be a practiced networker—more politician than physician. “Many would look at my career and think, oh, this guy's a networker,” he explains.

Yet Jain considers himself an outsider—a black sheep in the staid fields of medicine and government. “There was always this ‘outsider’ vibe in my family. It was part of how I grew up. I got comfortable never fitting in.” When Jain arrived as an undergraduate at Harvard, he joined the Institute of Politics—eager to understand how governments function. “I found that most of the other students in the IOP were interested in politics, but not policymaking. They were interested in “Republicans versus Democrats.” A young Jain had more practical concerns: “What is the right way to organize Medicare? How do we get to universal coverage?” 

As an undergrad (and then medical student), Jain became fascinated with finding the answers to these policy questions: “I just dove in and tried to solve problems,” he reflects. He attributes his subsequent success—working closely with Don Berwick at CMS and CMMI, conducting research with the likes of Michael Porter and David Blumenthal, leading teams at Merck and Anthem—to this “roll up your shirtsleeves” mentality. 

He learned this action-oriented approach from his father—a village doctor in India who immigrated to the US, re-training as an anesthesiologist and establishing Memorial Sloan-Kettering’s first pain management service. “My family gave me the confidence to forge my own path,” he reflects in our interview.

The path has been winding. Now as CEO of SCAN Health, Jain brings his diverse experiences in medicine, government, pharma and private health insurance to bear on an issue that has driven him from the beginning: efficiently delivering care to the most vulnerable patients.

SCAN is a not-for profit Medicare advantage program that provides healthcare to hundreds of thousands of elderly Americans.  During Jain’s tenure the program has expanded from California, to serve patients in four other states. Last December, SCAN announced its intent to combine with Care Oregon—a move that will make it a seven and a half billion-dollar organization with six medical groups, and Medicare and Medicaid lines of business.  As Jain explains, being a not-for profit has its advantages: “This is a David versus Goliath story. The managed care industry is increasingly dominated by a few big companies…but I think patients want to be the recipient of care that's driven by mission rather than hitting quarterly earnings targets.”

Dr. Sachin Jain has published over 100 peer-reviewed articles in journals such as the New England Journal of Medicine, JAMA and Health Affairs, and was an editor of the book, “The Soul of a Doctor” (Algonquin Press). He is adjunct professor of medicine at the Stanford University School of Medicine and a contributor at Forbes. He serves on the Board of Directors at Make-A-Wish America and the Soros Fellowships for New Americans. 

Whether training in medicine, conducting research or tackling the biggest problems in healthcare, Jain has a simple piece of advice for young people: “Get your hands dirty. Just dive in and try to solve problems.” Deep relationships, meaningful careers and true change are forged not at backroom cocktail parties, but “on the battlefield.”

Below is an interview with Dr. Sachin Jain, President and CEO of SCAN Group and SCAN Health Plan:

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1. You were initially interested in policy. Which early experiences pushed you towards medicine?

One of the earliest rituals in my childhood was watching the evening news with my dad—it was part of how we connected.

By osmosis I became interested in local and national affairs—so from a young age I leaned towards politics and policy. I never considered medicine, to be honest. The public image of a doctor at this time was Cliff Huxtable—every week I would ask my father, who was a physician, if he delivered any babies at work that day.  He would always chuckle and say, “no”—never mind that he was an anesthesiologist and pain management specialist.

I had this very “TV” vision of what it was like to be a doctor. Then in high school, a teacher of mine launched a course on the HIV epidemic. It was a very interesting course that merged the science of HIV, the politics that led to the discovery of the virus and the profound social issues and stigma that surrounded an AIDS diagnosis. I saw how closely tied medicine was to global health and policy—"medical sociology,” though I didn’t have this terminology at the time.

In my senior year of high school,  my father set me up with an internship working with Michael La Quaglia, who was chief of pediatric surgery at MSKCC and an icon in neuroblastoma surgery and research. This experience kept my interest in medicine alive, but I was more focused on politics and government at this point. 

Then I got to Harvard undergrad, and something interesting happened. I found that most of the students in the Institute of Politics (IOP) at the Kennedy School were interested in politics, but not policymaking. They were interested in “Republicans versus Democrats.” They were less focused on the substance of questions like: what is the right way to organize a Medicare program? How do we get to universal coverage? I was much more fascinated with finding the answers to these practical policy questions.

2. What specific experiences in healthcare policy drew you to the field of medical sociology?

In college I took a course—it was called Gen Ed 186—taught by Don Berwick and Howard Hiatt. Unbeknownst to me at the time, it was a “who's who” in American medicine. Howard had been the dean of the Harvard School of Public Health, and Don was the father of the modern healthcare quality movement.  The course was really a survey of everything interesting going on in American Healthcare taught by twenty of their [Berwick and Hiatt] best friends.

It harkens back to that early interest in medical sociology from high school, I just got super stimulated about improving healthcare quality. The following semester I organized this internship for myself through the IOP, to be at the White House Office of Science and Technology Policy under the Bush administration. For somewhat political reasons, the internship got cancelled two weeks before the summer of my junior year. By this point I had decided to apply to medical school, and I needed something to do before senior year. I called Don Berwick, and asked if I could spend this summer working with him. He agreed, and I had a really transformative experience working on a program called “pursuing perfection.” IHI and the Robert Wood Johnson Foundation were funding about 20 organizations to develop prototypes of “perfect” healthcare models.

I was involved in the selection process to determine which organizations would be funded. I started traveling with Don to review these organizations and hear their proposals. Just imagine being 20 years old, interested in healthcare policy and possibly in med school…I was like: “holy cow there are all these interesting organizations and people working on fundamental healthcare problems. This is what I want to do with my career.” This is the moment when it all came together for me.

3. What led you to business school once you started medical training?

When I got to my clinical rotations in medical school, I found out that I loved being in the hospital…every rotation was just amazing. In particular, I found medicine at the Brigham to be super inspiring. I loved the problem solving and felt like: “OK I want to do this for a career.” But I also had this interest in policy, and was planning on going to the Kennedy school to get a master’s degree. But my older brother, Narpat, said to me: “you’ve done all of this work in policy, and you majored in government in college. Why don’t you try out business?” At the time, Gary Gottlieb had been president of the Brigham and was an MD, MBA and Peter Slavin who led MGH was also an MD MBA. I had never heard of an MD MBA before and didn’t know much about that path.

One of the most amazing things about the Harvard medical environment is that you can literally email anybody, and they will meet with you. It's so cultural from the environment: when a student reaches out, you try your best to help them. I reached out, and Gary Gottlieb would meet with me at six in the morning before work. Peter Slavin said I could come shadow him. There were very few MD MBA around Harvard at the time—now you might trip over them, but there was no formal program when I started.  Also policy was beginning to feel super daunting: I did a project for David Blumenthal: when he was writing a book on the history of health care reform through the lens of the American presidency. I realized that between Lyndon Johnson President Bush senior, there was almost no change in health policy. It just moves super slowly in this country. I felt that if I really wanted to make change, perhaps at the institutional or organizational level, a business background may be more helpful. So that's how I ended up at HBS.

[On the MacArthur Program at BWH and HBS]

As a third-year medical student, I was somewhat ill-formed. As physicians, we have much clearer ideas of who we are, and what we want to do after residency. Ideally, business school is set up to help you launch into the next phase of your career.

There is something anticlimactic about being at HBS, when others are starting new companies, doing internships, getting job offers, and your next job is to be a “fourth year medical student.” I thought that the placement of business school would be far superior at the end of residency—when you have some more real-world experience.

I shared this insight with Joel Katz and the relevant folks at Harvard Business School. At the time, there was an interesting opportunity to fundraise for John MacArthur who had been the dean of the Harvard Business School and was the first chairman of Mass General Brigham (MGB). He was an iconic figure in Boston medicine and healthcare. I suggested that we name the program as the “John MacArthur program in medicine and management” and raise money to pay for doctors to get their MBA during residency. Now there has been a long line of people who are MacArthur graduates, Karl Laskowski who is a senior physician leader at Blue Cross Blue Shield of Massachusetts, Daniel Stein who was the Chief Medical Officer at Walmart Health, and is now the CEO and founder of Embold Health. If I had to do it all over again that's what I would have done.

4. Discuss the decision to take a leave during residency to work in government.

When I was in business school, I thought that being a business school professor seemed very cool. As an academic at HBS you can consult with companies and be on boards, but also teach great students. There were very few faculty at HBS who were practicing physicians. I got enamored with this idea and mentioned this to Jay Light, who was the Dean, when we were at a cocktail party. The next day he emailed me to discuss the idea more formally. 

That summer I also got connected to Michael Porter, who I met through my strategy professor. He had just written a popular book on healthcare reform and was perhaps the most famous business school professor at the time. There were cutouts of him at every airport and bookstore in the country—everyone was talking about “Porter's Five Forces.”  I got this amazing opportunity to work with him on healthcare. He and the business school dean offered me a “five-year contract” to start out as a staff researcher and then have an appointment in his department during my medical residency.

In retrospect, I was really like a postdoc, but it was couched as a faculty appointment. I started out at the Brigham as a “hemi-doc,” which is a 50% resident, 50% research. This is a path that is usually reserved for people like you: MD-PhDs who were going to be basic scientists and had promising lab work. With my background, I didn't really see myself as a researcher…even though I won the Harvard medical school research prize during my last year.  However, I wouldn't recommend the “hemidoc” to anyone: I think you should just do a standard three-year residency. When you split your time between clinic and research, you lose a lot of momentum and some of the social experience of being a resident. But putting all that aside, I was on this hemidoc track, when Barack Obama was elected president.

I immediately felt that I wanted to be a part of what he was building. A lot of Harvard people at the time were rumored to be going down to work in the new government. I told all of the “rumored people” that I would join them if they offered me a job. The first person to offer me a job was David Blumenthal—the position was as his special assistant and Chief of Staff.

I took the offer—I did everything from answering his mail, to helping lead some strategies on his behalf. I had an amazing year. Then Don Berwick was named CMS administrator, and I felt I had come full circle. I asked him if I could help get the Centers for Medicare and Medicaid Innovation started. I was one of the first few employees at CMMI, and worked with Don to get that off the ground. It was a pretty awesome experience. It was so cool to be part of the “primordial ooze” of health reform, and all these new policy instruments and authorities to build a new agency. When you get to meet such incredible people, it can be an accelerant to your career. When I was in medical training my “world” consisted of three hospitals: BWH, MGH and BIDMC. Then you go to Washington, and you realize that there's a whole country, all these problems, and no one cares about Harvard or Brigham.

So, I did that for about 19 months, and I came back to finish my residency in part because I just loved being in the hospital. I get asked a lot: “should I do residency?” One my best friends is Tom Tsang, who said to me: “Sachin you are building for a 40-year career, not a four-year career. Finish residency.” He was so right—after finishing medical training there is a whole world of things to explore.

[On pursing alternative career paths]

My senior year of medical school, I was dating a woman who was a resident at Johns Hopkins. She could not fathom the idea that I wasn't going to do subspecialty training. It was like I was some sort of misfit. So yes, there's a lot of pressure from all kinds of directions to be a cardiologist or physician-scientist investigator. But I was really trying to carve out my own path, and I had mentors who had done so. One of my role models was my father: he was somebody who grew up in India and was on the path to being a village doctor. However, he decided he was going to do something completely different and move to the US.  He intended to train in surgery, but as a foreigner it was hard to progress in residency at that time. He pivoted to anesthesiology and pain management when no one was doing it and ended up founding the service at MSKCC. There was always this “outsider” vibe in my family. It was part of how I grew up. I got comfortable never really fitting in. In addition, I was always someone who acted a little bit older than my age. I think it’s because I have brothers who are 9 and 11 years older than me. So, my family gave me the confidence to forge my own path and see beyond the immediate next steps of medical training.

5. You have had some terrific mentors. What is some advice about finding and retaining mentors?

The mistake that people make, especially at the earlier stages of their careers, is walking into an office and asking: “can you be my mentor?” The truth is that many folks are too busy getting stuff done to formally take on mentees or be a career coach. For example, someone who comes into my office asking for advice can find the answers in this article, or in another interview. 

But if someone came to me and said: “I'm really interested in homelessness in LA, I have an idea for something that I want to do to address this scourge.” I'd be like cool, let's do that together. I never approached mentorship through the lens of needing a guide or a guru. I approached it through the lens tackling some interesting problems and having a real conversation.

Many would look at my career and think: “Oh this guy's a networker.” No, I've actually done things with all these people. I've been on the battlefield with folks like Don Berwick and known him for decades. These are different kinds of relationships that you develop—when you're really in it with them. I would encourage everybody to think about this when they are approaching mentors. Just dive in and try to solve problems.

6. How did you come to get the position at Merck? How is working in pharma different that operating within academia or government? What were some of the biggest lessons learned from your time here?

With all due respect to my younger self, I had no business getting that job at that stage in my career. I met the folks from Merck when I was in government, and I stayed in touch with them and did some consulting. In my senior year of residency, I was looking for what I wanted to do next, and I was looking for a health system job in New York or Boston. When I was meeting prospective employers, it felt like they either weren’t interested in change or did not have the resources. In contrast, at Merck they were looking for a chief medical innovation officer reporting directly to the CMO, with huge resources for the office and 40 employees. They advised that I put myself in the process, and I got the job. Merck gave me a lot of help, but at that point I had never run a group or been part of a publicly traded corporation. I didn't even know what legal and compliance were let alone how to navigate them.

I built a phenomenal team—some of the best people I've ever worked with, some of my best friends come from this time. I made every mistake one could make in a compressed two-and-a-half-year timeframe, but I really got an education in how to operate in large organizations.

I think this time accelerated my development as an executive. It’s important to talk about making mistakes and things not going well. Eventually I found myself in a group that was being absorbed into another part of the organization. At that point I decided that I was ready to look for something new. I went to CareMore after my tenure at Merck—I was there for five and a half years and extended the company from 4 states to 12 and then 29, after the acquisition of Aspire Health. I was part of the national leadership team at Anthem, now Elevance, (of which CareMore was a wholly owned )—so it was a really exciting period of my career that led up to the opportunity to come to SCAN.

[On lessons learned at Merck]

When you're building something new in a large organization, you have to be deeply attuned to the sociology of what you are building around. At Merck our Boston group was geographically isolated from the rest of the company in New Jersey. We had responsibilities that were board-defined, but not communicated clearly to others across the organization. Some saw us as encroaching on their territory. In a resource constrained environment at the time, we got a $50 million blank check, which I think also rubbed a lot of people the wrong way.

We were very focused on getting things done. We were very results oriented, without sometimes paying full, full attention to sociology and bureaucracy. We were new at how to move things through the organization and bring legal, compliance and PR along. A member of my group once mistakenly published a press release without running it through global corporate communications. We were a publicly traded company, and we were making news that could potentially affect the stock price, and he skipped the process. We all learned a lot of lessons about how to get things done the right way: how to be good partners and collaborators.

7. Can you discuss the move to SCAN? What drew you to the opportunity?

SCAN is a renowned legacy brand in the Medicare Advantage space, with a 45-year history of doing the right thing for older adults. Historically SCAN was originally an activist group that then became a non-profit Medicare Advantage plan. Part of what we want to do know is diversify back into healthcare delivery. Over the past three and a half years, we've grown the revenues from 3 billion to 5 billion, we launched five new medical groups and medical care operations. Last December, we announced our intent to combine with Care Oregon—when we come together, we will be a seven and a half billion-dollar organization with six medical groups, and Medicare and Medicaid lines of business. We've also expanded our Medicare operations to five states (California, Arizona, Nevada, Texas, New Mexico)—soon we will add Oregon to our footprint as a combined organization under the HealthRight Group.

We are trying to reaffirm that nonprofit managed care plans have an important role in the ecosystem. In many ways, I would say that this is a David versus Goliath story. The managed care industry is increasingly dominated by a few big companies: United, Elevance, Cigna, Humana. We think that there should be a not for profit alternative in the government program space, in every geography. I think patients want to be the recipient of care that's driven by mission more than that it is by hitting a quarterly earnings target.

[What were the challenges in scaling this non-profit organization?]

We don't have the scale or capital of the big for-profit companies. But we also don’t have the strict margin targets that Wall Street demands. When I was at Anthem, we used to talk about “5%” as the target number that equity research analysts like to see in the Medicare line of business. On $5 billion that's $250 million of expected profit. That's $250 million that we [SCAN], as a not for profit, could potentially reinvest into our mission. In some ways this gives us a competitive advantage if we lean into it. But this means that have to operate as leanly as possible…and make the right strategic investments so that we're actually doing more for people.

8. How is SCAN using AI in their programs to impact care?

My view is very clear on this. Especially in the human services industry—like the provision of great healthcare to older adults and vulnerable populations—our job is to use AI to make humans into super humans. Think about your average customer service experience. AI should be able to augment that experience and augment the skillset of the person. When you do ask a question, it should be totally clear what to do, and how to do it in a very personalized way. A lot of people are talking about AI as “replacing humans.” I don’t subscribe to this view…but how powerful would it be if AI was enabling physician documentation? I don't think you want to be manually writing “SOAP notes” in 20 years. When you have your own practice, you would like the documentation to be done ambiently by AI. Again, this will make you a “superhuman” by allowing you to see more patients and just be more present with them. These are some of the issues we are beginning to tackle with Dina Care.

9. How has “toxic positivity” impacted the practice of healthcare in the US?

There are lots of scientific advantages that we should be positive about. We are now solving problems that were thought to be impossible when I was in medical school: familial hypercholesterolemia and sickle cell disease. I still have vivid memories of patients with intractable pain crises, loaded up on opiates and unable to have bowel movements. We are now in an era where our scientific advances are able to actually solve previously intractable problems. These are the advances that should be honored, and should be positive about.

Where I struggle is when we have incremental point solutions that don't really do very much for patients….yet some act like we're changing the world. This is where I use the term “toxic positivity.” For example, when workforce cultures are burning people out, but then are self-congratulatory about giving employees free yoga classes on the weekends. That's the stuff that I really reject. On the other hand, I'm over the moon optimistic and excited about true scientific innovations that actually solve real problems for patients.

10. What will the US healthcare system look like in 2050?

I think it's going to be a publicly funded multiplayer system. A privately administered globally capitated health care system that is paid for centrally (through tax contributions) and decoupled from employment. I think this is where we are going—a healthcare system that is going to be publicly funded through tax contributions but will rely on the private sector to administer it.

11. Favorite book on healthcare you think everyone in medicine should read? Anything you are reading right now that is outside of medicine?

I just read Sandeep Jauhar’s “My Father’s Brain” — which is  and was particularly meaningful as I lost my Dad just a little bit after.  Outside of medicine, I’m going to soon crack open Isaacson’s new biography of Elon Musk and see what all the fuss is about.

12. What are some misconceptions that the average American has about healthcare in the US? What are the biggest misconceptions physicians have about our system?

Americans almost uniformly expect that we know more than we do.  We don’t communicate enough about how much is unknown—and we saw that play out during the pandemic. 

Physicians have more power than they think to make the US healthcare system better—the next decade will be about reminding them of that power and unlocking it. 

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