Resolving Healthcare Leadership with SCAN Health Plan CEO Sachin Jain

Jain argues too many leaders are quietly complicit with a broken status quo.

In his latest Forbes column, SCAN Health Plan CEO Sachin Jain, MD cuts close to home.: He says the industry’s central failure is not a lack of ideas or talent, but a lack of nerve.

In a recent interview, Jain describes a familiar executive meeting dynamic.

 “Someone speaks up and they say the right thing, but they say it the wrong way,” he explains.

Colleagues privately agree but no one publicly backs the substance of the point. What’s missing, he argues, is the executive willing to say, “I agree with what so-and-so said, but I would say it a little bit differently,” redirecting attention from tone to truth.

That gap between private agreement and public silence is what Jain calls healthcare’s “quiet culture of corporate complicity.” Leaders tell themselves they’re being prudent, politically savvy, or deferential to unseen complexities. In reality, he says, they are reinforcing a broken status quo.

The rationalization is familiar to seasoned executives: Perhaps there’s a bigger picture. ; perhaps regulators, board members, or enterprise stakeholders see constraints you don’t.

 “We check the clarity that we have that things are broken because we think maybe there’s some bigger picture that we don’t really understand,” he says.

In waiting for that clarity, organizations normalize dysfunction directly in front of them.

Jain explains that many entered healthcare ” wanting to be a force for good, but where they end up is kind of being quietly complicit with a broken status quo.”

The drift happens incrementally, through unchallenged assumptions, tolerated misalignment between incentives and outcomes, and strategic caution that calcifies into avoidance.

In his framing, leadership resolve is not performative boldness, but backing the right idea even when it is imperfectly delivered.

Jain argues it’s about “saying and doing the right thing, even if it isn’t the right thing for you.”

Toxic Positivity

In his article Jain’s critique of “toxic positivity” in healthcare leadership lands on the insurance sector’s cultural fault lines, zooming in on the widening gap between stated mission and lived member experience.

After working with leaders across national and regional plans, he says the rhetoric is remarkably consistent, that executives are exceptionally mission-driven. But when he looks at day-to-day operations, he sees something different.

 “We deny claims, we make it hard for people to get the answers that they need,” he says. “We put obstacles in the way of their care, not facilitate it.”.

That tension between brand narrative and operational reality is, in his view, where toxic positivity takes root. Rather than confronting structural friction in prior authorization, claims adjudication, call center access, or network design, organizations lean into affirming language about purpose and values. The optimism becomes a shield.

“I think that we often normalize the abnormal and we don’t necessarily describe our state of affairs very clearly,” he says.

For healthcare leaders, Jain’s warning is less about tone and more about governance. Toxic positivity allows executives to avoid difficult admissions to boards, to regulators, and to themselves, about how financial incentives, utilization controls, and administrative complexity shape member outcomes. Furthermore, it sidesteps the difficult questions: Are denials aligned with value? Are friction points accidental or embedded in the business model? Is the organization measuring what matters or is it what’s comfortable?

Ethical Erosion and Performative  Collaboration

Jain describes ethical erosion not as scandal but as spreadsheet logic that gets left unchecked.

He gives an example: “You set up a productivity target for a clinic without really understanding what’s reasonable or what’s feasible or what’s possible, and you allow the financial bottom line to drive behavioral expectations of professionals taking care of patients.”

He argues that executives do this instead of doing the harder work of defining what produces appropriate outcomes.

Over time, he says, those seemingly rational targets normalize compromises in care.

Jain is equally critical of the industry’s reliance on the mantra “no margin, no mission,” arguing it “is predicated on the idea that the mission in itself is just.”. If revenue depends on people being sick and using services, he asks, why aren’t more organizations aggressively shifting toward prevention and value-based models?

 “In a world where most people are paid fee-for-service and you now have access to value-based care opportunities and many organizations are choosing not to pursue them,” he asks, “are you really mission aligned?”

Jain argues that values must be treated with the same rigor and visibility as financial metrics, including being made explicit, operational, and central to executive and board discussions. Leaders should consistently articulate and embed them into governance and incentives. Otherwise, values won’t withstand short-term earnings pressure.

He emphasizes that real change is measured by tangible outcomes and organizational shifts. For payers, meaningful initiatives must scale, reshape incentives, and alter core operations. CEOs build credibility by evaluating impact objectively and ending programs that don’t drive true change.

Too often, he says, insurers launch an initiative and secure favorable coverage, but “when you actually dig a few layers deep, you realize that a lot of it was just superficial because the underlying chassis of the organization didn’t change very much.”

Rebuilding Trust

Jain argues that much of the industry’s trust deficit accelerated during COVID, when leaders too often communicated “in absolutes” and projected certainty that circumstances quickly disproved. Moreover, he says mistrust deepens when plans fail to acknowledge operational shortcomings and instead default to scripted explanations or opaque processes.

Trust repair, in his view, requires visible vulnerability and responsiveness and admitting “we try to do the best we can… but we sometimes fall short,” and directly engaging members rather than “gaslighting them” about their experience.

For executives, the uncomfortable implication is that rebuilding trust may require more than brand campaigns or net promoter targets; it demands candor about performance gaps, faster escalation pathways, and a willingness to treat members as humans.