
Episode #16
Dr. Sachin Jain on Suing CMS, Fixing Prior Auth, and Why Health Insurance is Broken
What happens when a health insurance CEO admits the system is broken? In this episode of Good Medicine, Dr. Rohan Ramakrishna sits down with Dr. Sachin Jain — CEO of SCAN Health Plan, former CMS official in the Obama administration, and one of the most outspoken physician executives in American health care. Jain recounts suing CMS, his former employer, over Medicare Advantage Star Ratings — and winning — and explains how SCAN got out of the prior authorization business by letting provider groups police themselves inside global risk arrangements. He mounts a candid defense of Medicare Advantage as a social safety net for low-income seniors while conceding what John Oliver got right about risk adjustment run amok, and tells the story of the Togetherness Project, which operationalized loneliness as a treatable condition at scale. Along the way he makes the case that physician executives owe medicine more than code-switching: they should be translators who mold business policy around patient needs. A conversation about candor, incentives, and fixing health care from within.New episodes are released wherever you get your podcasts.Find us on Instagram and X: @roondoctorsIf you have a question, comment, or suggestion for a future guest, please email us: jane@roon.care -- (00:00) Intro (03:26) Meet Dr. Sachin Jain (04:11) From internal medicine to CEO of SCAN (06:50) Why he's so outspoken (11:23) Suing CMS over Star Ratings (14:34) “Career malpractice”: VP at Merck out of residency (16:52) Identity: son of immigrants (19:42) Managing the doctor–payer tension (22:00) Prior authorization: why it exists (25:24) How SCAN got out of the prior auth business (27:02) Medicare Advantage 101 (32:08) Flat benchmarks and benefit cuts (35:15) John Oliver: what he got right and wrong (37:38) How a nonprofit competes with the giants (40:26) Vertical integration and antitrust (42:48) The Togetherness Project: treating loneliness (46:34) Health equity products at SCAN (48:54) “Health Insurance Is Broken” (50:55) Quick Hits: books, dinner guests, and anthems






