SCAN Health Plan is stripping away the traditional hospital-based prerequisites for patients transitioning to skilled nursing facilities (SNFs). By authorizing direct transfers from home to SNFs, the organization is scrapping the industry-standard mandate for a two-day hospital stay to slash wait times and accelerate care for its Medicare Advantage members.
Ending the Two-Day Inpatient Mandate
For many health plans, a two-day inpatient hospital stay is a non-negotiable hurdle before a patient can be authorized for a skilled nursing facility. SCAN is ending that requirement.
Speaking at the Home Health Care News’ PAYER Summit in June, Quingan Zhou, vice president of growth strategy and ops at SCAN, confirmed the plan now performs direct SNF authorization. Zhou argued that the two-day hospital stay requirement "doesn’t make any sense" within modern care pathways. The result is a leaner utilization management process; authorizations now typically occur within the same business day or one business day.
Infrastructure for 425,000 Members
The transition to a direct-to-SNF model was a complex lift for clinical operations, but the move was driven by a push for timeliness. SCAN, a non-profit serving more than 425,000 Medicare Advantage members across six states, operates its Embrace institutional special needs plan (I-SNP) in California and Arizona.
That specific plan serves over 4,000 members, focusing on those who are homebound or residing in assisted living facilities and nursing homes. Zhou noted that SCAN’s non-profit status provides a strategic advantage, allowing the organization to prioritize long-term technology and infrastructure investments over the pressures of quarterly earnings reports. These investments are what enable the workflow necessary to support providers through direct authorization.
Challenging the ‘Normalizing of the Abnormal’
The shift is part of a larger effort to dismantle healthcare frictions. Zhou emphasized that payers and providers share a collective responsibility to avoid "normalizing the abnormal."
To that end, the organization is engaging provider partners to overhaul benefit designs and payment structures. The goal is to identify and purge inefficiencies that complicate care delivery. By building partnerships where both the payer and provider emerge in a better position, SCAN is integrating this collaborative model into the growth strategy for its general Medicare Advantage offerings and its special needs products.
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