Statement of SCAN Health Plan

Overview

SCAN Health Plan is a geriatric-focused health plan that has been participating in the Medicare program for over 20 years.  Currently serving approximately 100,000 beneficiaries in 7 Southern California counties, SCAN has grown to become one of the largest Medicare health plans in the State. 

As a non-profit health plan, SCAN is committed to providing value to its members.  While SCAN ensures that members receive the health care benefits to which they are entitled through the Medicare program, the health plan also provides additional programs and services to promote health and independence.  Examples of some of the “extra benefits” offered by SCAN that are not otherwise available under the fee-for-service program include: vision and hearing benefits, and transportation services.  Because SCAN is a geriatric-focused health plan, its programs and services are tailored to meet the needs of older adults.  For example, the health plan provides chronic care management programs, a nurse advice line, and comprehensive prescription drug benefits. 

Collectively, these benefits and services provide value to the Medicare program and to Medicare beneficiaries.  In addition, they help to ensure that SCAN members have the resources they need to lead a healthy and independent life. 

SCAN Health Plan

History

SCAN was founded in 1977 as the Senior Care Action Network by a group of twelve seniors in Long Beach, California.  In 1984, after being awarded a contract to operate as a Social HMO demonstration project, the Senior Care Action Network established SCAN Health Plan as a 501(c)(3) not-for-profit Medicare managed care plan. 

Since 1984, SCAN Health Plan has maintained the mission of the Senior Care Action Network – that of coordinating health and social services for frail older adults.  SCAN aims to continue this mission by developing partnerships that allow the health plan to deliver the right health care, in the right setting, and at the right cost.

Today

Over the past 20 years, SCAN has become an increasingly popular choice for seniors in Southern California.  Currently, the health plan serves almost 100,000 Medicare beneficiaries in seven counties that include Los Angeles, Orange, Riverside, San Bernardino, Kern, Ventura, and San Diego.  In addition, SCAN recently expanded into the Phoenix, Arizona area.  Demonstrating the success of the health plan, SCAN’s membership has grown nearly 100% in the past 5 years.

Offering Additional Benefits and Services

To participate in the Medicare Advantage program, SCAN provides coverage for all of the services offered through the traditional Medicare program.  This includes the full range of acute care benefits and Part D drugs.  In addition, SCAN currently offers a number of health care related programs and services to meet the medical and functional needs of health plan members.  The following is an overview of some of SCAN’s geriatric-focused “extra benefits” that are not covered by the traditional Medicare fee-for-service program:

• Transportation – SCAN provides routine transportation to medical appointments.  This benefit helps to ensure that frail members, such as those who are no longer able to drive, can access needed health care services. 
• Nurse Advice Line – With access to registered nurses (RNs) to assist with medical questions 24 hours a day / 365 days a year, SCAN members can have their health care concerns addressed outside of traditional physician office hours.
• SCAN Family and Friends Program – This program gives SCAN Health Plan members the option of designating a friend or family member to receive non-confidential health plan material.  These individuals can then review important information at the same time as the member to help ensure informed decision-making.
• Community Resource Centers – SCAN has built one community resource center in Ventura County, and is in the process of building a second resource center, to provide members of the health plan and the general community with health-related educational information and activities.
• Health Education Programs – SCAN helps members become active and engaged in the management of their own health.  As such, the health plan distributes health information through newsletters, handbooks, and the Internet.  Member Review Board – To ensure that health plan materials are sensitive to member needs, a peer review process is employed by which current members review current health plan activities and information. 
• Chronic Care Management – Specially trained nurse or social worker case managers assist members from a patient-centric point of view. The health plan has designed programs for individuals with particular health needs such as Chronic obstructive pulmonary disease (COPD), Congestive heart failure (CHF), and diabetes.
• Senior Sensitivity - Each of SCAN’s approximately 950 employees participate in the industry’s foremost “Senior Sensitivity” training to help them be more attuned to the needs and challenges of health plan members.
• Continuing Medical Education – SCAN strongly believes that educating providers of care is a prerequisite for delivering good quality geriatric care.  To this end, SCAN built its own continuing education capacity.  The health plan offers geriatric education through Geriatric Symposiums as well as on–site trainings.
• Additional Drug Benefits – SCAN offers an expanded prescription drug formulary and a fill-in of the “doughnut hole” or coverage gap. 
• Senior Friendly Focus – SCAN always has seniors in mind with every decision that the health plan makes.  From the absence of automated phone systems to the distribution of pill holders, SCAN Health Plan promotes member health and well-being.  In addition, SCAN’s trained member services team provides personalized one-on-one assistance.

Serving Vulnerable Populations

With the provision of the additional benefits and services listed above, SCAN offers a health care delivery solution that is unrivaled by the fee-for-service Medicare program.  The health plan provides these services because of its focus on serving the most vulnerable and frail Medicare members.  The following table provides an overview of SCAN’s membership. 

 Table 1.

As illustrated in Table 1, SCAN’s members are predominately female, unmarried, and have an average annual income of less than $20,000 per year.   In addition, the average age of members in the health plan is approximately 78 years.  As compared to the general Medicare population in the State of California, SCAN’s membership is on average older.

SCAN vs. Other Medicare Advantage Plans

SCAN serves a population that is more frail and chronically ill than other Medicare managed plans[1].  Specifically, SCAN members are:

• More likely to be female and less likely to be male.
• Less likely to be married and more likely to be widowed.
• More likely to be over 80 years of age.
• Less likely to have 0 chronic conditions and more likely to have four or more chronic conditions.
• More likely to report having high blood pressure, angina, CHF, AMI, stroke, Crohn’s disease, arthritis, and sciatica. 
• More likely to report difficulty on each surveyed measure of Activities of Daily Living (ADLs) such as: bathing, dressing, eating, walking, using the toilet, and getting in or out of a chair. 

The following table highlights some membership statistics from a recent HOS survey.

Table 2.

Providing Extra Value

SCAN offers considerable extra value to its enrollees by offering benefits and services, above and beyond those covered by the traditional Medicare program.  Without this coverage, members would have to pay significantly more out-of-pocket for many of their health needs.  This is a major reason why a significant percentage of SCAN’s members are lower income seniors. 

Generally, these are individuals whose incomes are not low enough to qualify for the Medicaid program but whose financial situation is such that they are extremely cost conscious.  Having low out-of-pocket costs is also particularly important for members with considerable health needs who utilize more medical services. 

Offering High Quality

SCAN offers multiple quality improvement activities geared to improve the health care delivery experience for Medicare members.  These include:

A Geriatric Advisory Board – SCAN sponsors a Geriatric Advisory Board that brings together a group of the nation’s foremost geriatric, clinical, and health policy experts to help guide the health plan in its offering of geriatric health management programs to seniors. 

Coordination of Care – SCAN coaches members with high intensity and high cost needs through care transitions, or between care settings.

Focus on early identification of conditions, preventative services, and stratification of patient risks.

Monitoring of quality measurements that are not provided to Medicare members in the fee-for-service Medicare program.

Conclusion

Because SCAN is a geriatric-focused health plan, its membership is on average older and more frail than the general Medicare population, and than other Medicare managed care plans.  The numerous additional benefits and services provided by SCAN Health Plan, above and beyond the fee-for-service Medicare program, help to ensure that members have the resources they need to lead a healthy and independent life. 

Looking forward, SCAN intends on continuing to provide health care services to senior Medicare beneficiaries.  For the past 20 years, SCAN’s almost 100,000 members, 950 employees, and thousands of contracted providers have come to depend on us, and us on them.  With your support, we can ensure that managed care plans remain a choice for Medicare beneficiaries.

[1] As indicated in the April 2006 Health Outcomes Survey (HOS), Cohort VIII, 2005.