The Health Pulse

[AUDIO LOGO] SARITA MOHANTY: When I came in, I said, what's missing? Why aren't these solutions that we talk about that is supposed to fix the health care system and make it more seamless and make it less fragmented, why aren't they working? It's because we haven't, again, designed the systems with the inputs of older adults in mind.

ALEX MAIERSPERGER: Loneliness is as bad for seniors as smoking 15 cigarettes per day. We're all aging. What are the ways we can do so with purpose and dignity? In today's episode, we talk to President and CEO of the SCAN Foundation, focused on aging populations, Dr. Sarita Mohanty.

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I'm excited to learn about the SCAN Foundation and the general sense of foundations within health care. There's obviously ones attached to health plans or there's ones attached to hospitals. There's freestanding ones, family offices. And they all have different focuses. The SCAN Foundation is unique in the focus on aging populations. Can you tell me more about how that came to be?

SARITA MOHANTY: Yeah. Well, it's a really interesting story because I-- so we were created by the SCAN health plan back in 2008. And SCAN, which stands for Senior Care Action Network, if you look at the acronym, was founded-- it was founded, actually, in the 1970s. It was this group of older adults, and they're often referenced in the nicest way as the 12 angry seniors.

And they were basically determined to age with dignity and independence. And they basically said, they were not happy with the state of affairs with health maintenance organizations, HMOs. So they were like, all right, we need to go and create a social HMO. And that's what they did.

So that spirit still guides us here at the Foundation. So it's been almost 20 years since we were created, and we were created to advance what we describe as a coordinated and person-centered system of care for older adults. And it was born as-- SCAN is a Medicare Advantage plan, so deep roots in aging. And they were also very focused on community-based care. So that's where we were born.

But the Foundation operates independently, and we have our own mission. We have our own vision, strategy. So our vision is that all of us age well with purpose. That is, everybody ages well with purpose. And our mission is to be bold and be equitable in the solutions in how older adults age in home and community. So we are really about, what are those policies and programs that need to support people's ability to live in the home and in the community?

So while we're California based, I would just say, our work is-- ultimately, it's designed to shape state-level, federal-level, and even market-level changes. We use what we learned locally, like in California, for example, to inform system changes across the whole United States and at the federal level.

And then you ask, what makes us unique? It's not just what we focus on, but how. We are really double downing on, how do we elevate lived experience? How do we really look at data-driven action? How do we champion that? And we use both grants, and we use impact investments to advance home and community care solutions. So we are conveners. We commission data, like I said, investments. So that's where we are unique as an independent public charity, but still very rooted to how we were created.

ALEX MAIERSPERGER: This year, I was sick on my birthday. And I did not feel like I was aging gracefully and well. So I fully support the mission of supporting aging well. And from a health plan leadership standpoint and from a foundation leadership standpoint, you're a practicing physician. You've been a commercial leader on both the hospital side and the health plan side. Was your eye set on foundation leadership at some point, or how did you end up here?

SARITA MOHANTY: Yeah. It's always-- a lot of people ask me this question, because they look at my career path, and they say, how did you get to be at a foundation? And I-- actually, I'll be very frank. I did not-- when I started out as a physician and went through my career, I did not see myself eventually leading a foundation because I just didn't see it on that roadmap.

But I think what happened is-- I guess it goes back to I've always been guided by a real core question. And the question really is, where can I make the biggest impact? And as a physician, I think it started firsthand, seeing how our health care system fails, particularly for vulnerable, marginalized communities, older adults, especially those that are low income, living alone, are from communities of color, live in rural settings where there's minimal resources.

And I often, like-- I'll go, and I have so many anecdotes of patients in their late 60s who came-- I had one patient, for example, in his late 60s, who came into an urgent care, and he was dizzy. He'd just been dizzy, and he didn't want to be there. He was worried about missing work shift because he needed that income. He needed that income to cover his rent, his co-pays, his groceries. He had Medicare, but he had no supplemental coverage. So he lived alone, and he had no support system as well.

So he told me, this visit to this urgent care is not my priority. He was actually asked to come because his neighbor said, you need to go because you're dizzy. You need to go figure this out. And those kind of moments stay with me because it wasn't just a clinical issue. It was a structural failure. Because it came clear to me that no matter how much we deliver what I call the downstream health care, we're not addressing the upstream causes of poor health-- home and community care supports, affordability, maybe a fragmented support system.

In this case, this guy had real challenges with affordability. He was also socially isolated, lonely, had no support system. So I think, just going back to your question about why I'm in this foundation, I came-- I actually-- I was at a big hospital system before I joined the Foundation a little over four years ago. And I saw how business models and I saw how policy could either reinforce those barriers or transform them. So I saw both sides of the challenges.

But I also recognized that real change takes more than just those operational fixes that we're working on. It takes-- you have to-- it's actually a whole mindset, a fundamental thinking, or rethinking, I guess, of how we design systems around people's lived experiences. And that's really what brought me to the SCAN Foundation. So that's my story. And four years in, it still has been a tremendous opportunity to think about those system changes.

ALEX MAIERSPERGER: You talked about the system side of it. And sometimes it's framed as a health versus health care or health and health care investment thesis. There's a few, obviously, popular books or different things in health care that attribute many of the cost challenges of our health care system to end-of-life care. And a lot of them place blame not solely on the health care system, that it costs a lot, or that it's hard to access, or different things. They blame it on the culture that we have.

We have a higher proportion of our elderly in care homes instead of at home. Or generally, it's talked about often that we live in a society that we live far from our parents, even at the end of life. And so kids are across the country or across the world.

I also see those headlines about loneliness. You talked about that. They say it's as bad for our health as smoking, with seniors increasingly reporting being lonely, probably from that lack of access to family or close friends or different things. Are these things true? Is this a cultural problem that we see, or is it a headline that isn't true? Is it cultural or health care the challenge of aging?

SARITA MOHANTY: I actually think it's a false dichotomy. I think these are health care, cultural, and social challenges, all kind of wrapped together. When we think of end-of-life care, it can be expensive. But, actually, more often, we find that-- yes, at some point, certain people are going to need end-of-life care. But what do we find often is that the problem is the fragmentation and the systems that don't reflect what people actually want as they age.

And so, at the end of all of this, they get into this situation where they don't know where to turn. And it's kind of at the more acute end stage. And I think there's still ways to think about prevention and health earlier. But that being said, end of life is part of the continuum of care. And again, I'll just reiterate, if we can go more upstream, develop more seamless, less fragmented, more coordinated systems of care, we will be more prepared for that tail end of the continuum of health that is needed.

So I-- I mean, I think-- going back to your question, I'm thinking about the cultural aspects of being in nursing homes. I think there is a little bit of that, though, like, well, when somebody gets really old and they have disability, that means they're going to be institutionalized. And I am of the mindset-- I think many people are-- thinking, well, no. Where do people-- what defines dignified, purposeful life in aging?

And if you talk to most older adults, they will say-- or as people are aging-- no, I want to be able to be in my home and my community. So I think-- so to that point, to what you said, I agree. There needs to be some type of, I would say, mind-- like, that we can do more in the community.

And I think, now, even with the advent of-- we'll talk more, I think, about wearables and other things. There's more opportunity-- and also, I think, communities coming together to integrate and socialize together, I think, are some real ongoing opportunities, because when we talk about loneliness among older adults, which you also referenced, it's not just this emotional experience. It's a public health issue.

You talk about smoking. Yeah, they say that loneliness for adults can be as serious as smoking 15 cigarettes a day. And we know-- there's statistics now that show more than 1 in 3 adults over 45 report feeling lonely. So we clearly have this. This is coming up. Even at the federal level, our leaders in health care are talking about, how do we start to address loneliness?

But I think it's more than just prescribing a social activity or raising awareness. You got to have real system-level responses. You need better infrastructure, stronger community connections, and you need policies that really will fund, support people as they age in the places they actually call home.

So there are definitely some examples out there that are starting to have emerged or are being worked on. And I think those are the-- that's the real-- going back to that, I think we get careful of just calling it a cultural norm in terms of the situations we're in.

ALEX MAIERSPERGER: I love that, though. And you talked about the SCAN Foundation being an investor and just thinking like an investor where you said it's not a singular choice. You can't only invest in one of those aspects. You have to invest in the health care side, in that health side, the cultural, and the social side. So really love the full-pronged approach there.

We've learned about your background. We've learned a little bit about the SCAN Foundation. We've learned a little bit about the challenges that we're facing from an aging gracefully and with dignity and purpose. Now we're going to learn a little bit about you, maybe some outside of work. So you've made it to the speed round, meant to be fun and fast paced and getting to know you a little bit better. So favorite app on your phone?

SARITA MOHANTY: OK. Well, I think, for me-- I'll go quickly-- Amazon, unfortunately, a little too much.

ALEX MAIERSPERGER: That's awesome. Are you a morning or a night person?

SARITA MOHANTY: Definitely a night person.

ALEX MAIERSPERGER: I'm with you on that one. Mountain or beach?

SARITA MOHANTY: Definitely a beach.

ALEX MAIERSPERGER: Solid. Next up on your travel bucket list?

SARITA MOHANTY: I'm going to Patagonia. Can't wait.

ALEX MAIERSPERGER: Oh, that's awesome.

SARITA MOHANTY: Yeah, and then the Galapagos, as well. So there's definitely some opportunities coming.

ALEX MAIERSPERGER: You owe us a follow-up picture episode. We'll just--

SARITA MOHANTY: I will do.

ALEX MAIERSPERGER: --share those. Awesome.

SARITA MOHANTY: Absolutely. Yeah.

ALEX MAIERSPERGER: This is very important question to set up the next question. You'll see why here in a second. What is your favorite type of exercise?

SARITA MOHANTY: Pilates.

ALEX MAIERSPERGER: All right. So the follow-up question is, what is your favorite ice cream flavor?

SARITA MOHANTY: Oh gosh, which counteracts all the Pilates that I do. It's-- actually, I have a new favorite-- sea salt caramel.

ALEX MAIERSPERGER: Ooh. Great. A great addition to the-- so Pilates and sea salt caramel. I think you're on to something.

SARITA MOHANTY: Yeah.

ALEX MAIERSPERGER: All right, so we talked about challenges. We talked about where you're from, got to know you a little bit outside of work. You alluded to this, of some of the challenges that aging populations are facing potentially can be solved with technology or the human and technology combination. What is the technology opportunity to help senior populations like?

I see in the headline that there's-- obviously, we all see it at different points, that the early adopters in technology are on the younger side. But there's a lot of myths in that area. I saw a recent survey that said, over 30% of ages 65 plus own a wearable or connected device and are tracking one or more health metric digitally and daily.

And then-- so that opportunity there of, like, we know a lot of seniors are technology literate and are using technology to the most advantage that they have. So what is the opportunity like in the aging population? Is technology going to be something that solves some of these loneliness challenges and some of the prediction of who needs what and when and where?

SARITA MOHANTY: Yeah. First of all, I think technology has a real has a real place and opportunity for supporting senior populations, older adults. It's like you already mentioned. The tech adoption among older adults is growing rapidly. And I think one of the things I will continue to elevate and reinforce is that there's so much tech, and yet the question really becomes, is tech designed with these individuals in mind?

We have certainly predictive tools that can help identify needs before crises occur, like health risks, unmet social needs, but only if they reflect the lived experiences and the diverse realities of older adults. You can't cookie cutter this approach. The technology really has to be adaptable or respond to the nuances of the individual, whether it's language, whether it's culture, whether it's where they live, et cetera.

So we at the Foundation have done some work-- our grants and impact investments, just thinking about where technology can play a role. And of course, AI, artificial intelligence, we can't have a conversation about tech without talking about AI. And I think, just at a high level, we have been thinking about, how do we make sure that those AI algorithms that address-- that they truly address bias and work for our priority populations, which are typically lower income older adults, lower-- yeah, lower income older adults or those that have less resources or from communities of color.

And so that's really-- it has to be the right technology. And that's where I think that this is what we're seeing. And in some-- or I think some of the tech I've seen is really where they don't just say, here's a wearable in the health care system. Go use it. And it's like, let's, one, make sure you know how to institute it. Like, what is-- so, for example, one health plan I know has created geek squads for older adults to, like-- they can go in, and they can help set up their app and make sure that they really understand the inputs that need to go in and all of that and how to use it effectively, and often not just with the older adult, but it's usually like with the family member or caregiver, because a lot of times they may not be dealing with their health alone.

So-- and I think there's so much opportunity in prediction prevention in health. And you talked about socialization. There's social apps that are coming up where people can network with one another, go do Zumba classes. There's so many things. And it's also getting more predictive, so identifying who might need that socialization or that help before a crisis.

So somebody socially isolated, like that 60-year-old man I mentioned, that patient, is there's now-- like, how do we identify ways to say that this person is living alone, and are there solutions that we could offer to him so that he can get more engaged with the community, for example, especially his community around him? And so that's really what I would just say, is I think the world is our oyster when it comes to this. But we got to be really thoughtful of how we design them and engage the recipients of these technologies.

ALEX MAIERSPERGER: Really fun to hear your excitement of applying humans and technology to just the pressing challenges of our time. You've said you have a mission to uplift the voices of older adults. Where does that come from, and what does that look like exactly?

SARITA MOHANTY: Yeah, I think it comes from just having seen a health system that continues to have some real grave challenges. And what-- we continue to try to do the same, and it's not all working. And I think really what I did is-- and I think many others are doing this as well. But our organization, when I came in, I said, what's missing? Why aren't these solutions that we talk about that is supposed to fix the health care system and make it more seamless and make it less fragmented, why aren't they working?

It's because we haven't, again, designed the systems with the inputs of older adults in mind. And so we went on this journey. We said, OK, we got to start by listening to older adults and especially those from communities often-- there's a lot of communities that are often left out of the conversation. You think about a rural population, those with real limited income. Sometimes they just get left out.

So that was really-- and we were saying-- like, we talked to policymakers. We talked to leaders who said, when we think about policies, certainly the data is important, and these are the problems, and here's-- but we often remember why we're instituting this policy because we hear about the stories and the issues that are coming directly from these people, from the older adults in this case.

So our grants are now supporting the integration of lived experience into policy and into system reforms from long-term services supports, to integrated care for dual eligibles who are on both Medicare and Medicaid, to the development of something called the multisector plans for aging across the country.

So I'll give an example-- very brief example. We helped, a little over a year ago, institute or create a platform. It's called The People's Say and peoplessay.org. And basically what it is is that you can go on this platform, and what we did is we had an entity that a partner of ours called the Public Policy Lab, or PPL. They go into the homes or into the community or into the health center, and they talk to these older adults, and they ask them questions about, what's working in the health care system? What's not working?

And they're recording their stories. And these stories are now curated on this platform. And you or I or anybody could go in and say, OK, I want to hear an older adult's perspective on financial security or financial insecurity or food insecurity. And you can query, and you can get the stories there.

And those are supposed to-- you can apply those to when you talk about an issue. And let me pair what the data says with a story of an individual. And this is why this policy is so important. And we did it in eight geographies. It's actually expanded to more geographies now, all different-- red, purple, blue states, somebody who's just on Medicare, somebody who's a dual eligible, somebody who speaks only Spanish. We tried to really make it as representative-- rural, urban, suburban.

So anyway, my point being is that goes back to our earlier conversation. We can use that tool to improve technology and AI, making sure the end user has a voice, making sure that they know that their voice led to something of change. One of the things we often do in health care and in society is we often do this what I call the helicopter. In fact, we come in, and we say, we know your problems. Here's the solution.

And then we might ask them for some input, but then we never tell them what the results were of their input. And so we're really trying to have this-- and the people say, we can actually-- they've consented to let us follow up with them. And we can follow up and say, hey, it's been a year. What has been going on in your life since we last spoke?

So, again, I think these are where-- and we're still testing this out. It's a multimodal process. I think we can bring-- we use different tools, polling, like People's Say, talking to community-- there's so many ways you can bring diverse perspectives to this conversation.

ALEX MAIERSPERGER: I think I've used this podcast as a way to learn and get better personally. We had a cancer care researcher on, and so we asked, what is the common advice you give for us not to get cancer? And we had a patient advocate on and said, when we go to the doctor, what's the common advice you give to tell us how to navigate going to the doctor and going through a health challenge? Are there things that we should be asking at every appointment? Is there something we should take with us? Is there a person?

So I would love to get your advice on aging. If we're going through the aging process or if we're hitting retirement age or starting to think through what our next version of life is going to look like in a changing life phase, is there common advice that you give now that you've seen and collected all of these stories and that you've been in this work for a while?

SARITA MOHANTY: I mean, first and foremost, all of us are aging. Aging is a process. So I think we often-- what I've noticed is there's still a lot of fear when we talk about getting older and understandably because you're worried about-- I won't be able to do the same things I did 10 years ago. I won't be able to play tennis. Because disability-- as you get older, you're more likely to have some level of disability or comorbidity.

But I think the advice I give, too, as I think about this or talk about it, is, one, what are the things that give you joy, that give you purpose? And try to hone in on those as you age. And you may have to adapt. But at the same time, do the things that give you joy and love and support and connection. So that's the other thing, is to the extent that-- with families and friends and community, what are those offerings? What are the things that you can do that-- and then, on the flip side, the communities need to also step up, I think, and we, as communities, have to-- I live in a community. I need to make sure that the people around me are healthy, and we can convene as a community to help.

And there's examples of that we've seen where one community we helped fund with other foundations is now created a whole community manifesto to say, how are we going to take care of our older adults? Because many of them are isolated, lonely, and so they've created the whole support system for their communities for older adults. And churches can be that vein, as well.

I think those are some of the things. The other thing that I often see is that we tend to think about health, again, more medicalized as-- so it's about, let's just-- we got to be thinking about those gadgets and things that are going to help us physically. But it's the emotional, mental, spiritual. Those are going to really be your assets to improving your health.

So we look at it from a holistic, person-centered, and community-centered approach to health. The last thing I'll just say is that affordability. We know that health care remains, for many people, unaffordable. And right now, Medicare doesn't cover long-term care, for example, because you're only 100 days. So what are people going to do when they need 24/7 assistance or even three, four hours to help them with their activities of daily living? They're going to have to pay out of pocket. And if they don't have that pocket to go into to pay-- so it's about then thinking about creative mechanisms to help people save to the best of their abilities. And we need to be thinking about more of those and saving earlier.

So I tell a 20-year-old now, start saving for your needs of aging. When you get to that age, you may need to tap into that bucket and get-- because we can't assume that government's going to cover all of that. So those are some of the things that I-- but I try to aim with a positive to just-- you got to think of-- it's hard. But that's what we're aiming for in our foundation, is about purposeful, dignified aging.

ALEX MAIERSPERGER: Such meaningful advice and such-- I love that you started off with the joy and the purpose, and that seems to be such a great focus. Like you said, we're all aging. And so at any stage of life, focusing on the things that bring you joy and bring you connection to others can set yourself up for a long, fulfilled, happy life. Such a wonderful conversation. Thank you so much, Dr. Mohanty, for joining The Health Pulse podcast.

SARITA MOHANTY: That was wonderful. It's great to connect with you, Alex. Thank you.

ALEX MAIERSPERGER: Thank you for listening. If you have a favorite brand of sea salt caramel ice cream or if you'd like to join us as a guest, please email us, theHealthPulsepodcast@sas.com. See you next time.

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Loneliness-- bluh bluh bluh. Loneliness-- loneliness. Hmm. Oh, wait. What was her ice cream flavor? We're going to do the end, too, right? I know she said "care-uh-mel," and I couldn't do it. I said "car-mel." [LAUGHS]. Thanks for listening. One take when it's about ice cream.