SCAN Group and Sutter Health are teaming up for a long-term partnership in which they will build new Medicare Advantage products in Northern California.
The two partners said they intend to launch the first products in 2026, and that there are plans to build an MA plan joint venture in the future. One critical element to the joint work is developing specialized MA plans that can meet the diverse needs of the Medicare population.
Aparna Abburi, CEO of Sutter Health Plan, told Fierce Healthcare that taking a one-size-fits all approach to the senior population doesn't work and it's critical to reach different pockets within that group.
For example, some individuals are just now aging into Medicare, and would want to maintain continuity of care with Sutter providers they already see. Those in a middle group, or who have already been enrolled in Medicare for several years, have different social and behavioral needs than the newly Medicare eligible and the oldest people in the program.
"We will be at the forefront in bringing a group of assets that we own, and then what they bring to the table," Abburi said. "That's the part that gets really exciting, and where we can truly have an impact on the complex population we're going to serve."
For the plans to launch next year, members will have access to Sutter's provider network, including hospitals, urgent care and other services. These members will have a Sutter Health primary care provider to serve as their "healthcare partner," leading the coordination of their care journey.
They will also be able to tap into Sutter's digital health programs, chronic disease management offerings and more, according to an announcement from the organizations.
"I think for far too long, there's been kind of tension between payer and provider, and what we're trying to do is get us both on the same sides of the table, as opposed to having us on opposite sides of the table," said Sachin Jain, M.D., CEO of SCAN Group, in an interview with Fierce Healthcare.
"And I think we want to be partners to providers in enabling them to do what they do best, which is to actually take care of patients," Jain said. "And I think we have an incredible opportunity here with Sutter to prove the art of the possible to the whole healthcare industry, which is that plans and providers can work together to make a difference."
The planned joint venture will initially focus on Northern California, though the partners are considering expansion in the future that could reach a broader swath of Medicare beneficiaries.
Both the 2026 launch and the intended joint venture work will be subject to regulatory review and approvals as part of the Medicare Advantage program, according to the announcement.
Conrad Vial, M.D., president of Sutter Health Network, told Fierce Healthcare that payers and providers have generally operated in "parallel universes," which can prevent both from realizing the potential of working together.
"It's been really difficult to to for each party to prop up and sustain a durability principle," he said. "And I think that's because each side has been sort of working with their best of intentions ... but working through processes that fundamentally aren't integrated."
"And oftentimes mechanisms of association at an incentive level that don't necessarily square very effectively with one another, and that's because they haven't been co-created," he said.