Hello, everyone. This is Jacob Emerson with the
Becker's Payer Issues podcast. Thrilled today to be
joined by Steve Tringale, who is the president
of Mass General Brigham Health Plan. Steve, thanks
so much for taking the time to be
with me on the podcast today. Thanks, Jacob.
I am, Steve Tringale. I've been president
of Mass General Brigham's health plan
since
2000.
I have over
thirty years experience
working with both health systems and health plans
as both
the lead consultant
and as
a business strategist
as well as having operational
responsibility
for major product lines,
not only at Mass General Brigham, but in
a prior stop with a different carrier in
my earlier career.
I was asked in 2020
to come in
into build out a vision for Mass General
Brigham's health plan,
which included a full product line portfolio
so that every member who is
using a Mass General
Brigham provider can find a Mass General Brigham
health plan product
that will support,
their journey through the health care system. So
we have taken that
and our focus on the members sort of
our North Star and
have built out a full product portfolio,
which includes commercial products,
Medicare Advantage,
a
very large, in fact, the second largest Medicaid
ACO,
in the Commonwealth Of Massachusetts,
and now,
dual eligible products in both the 65
and the 65
market. So we have pretty much rounded out
a full portfolio at the plan.
Right. And let's stay on the topic of
of the dual eligible special special needs plans.
You announced earlier this year that you're planning
to enter that space in in 2026.
So talk to us a little bit about
why the the health plan made this decision
and, ultimately, how you're building on your existing
Medicaid experience, serving that population to really ensure
that there's meaningful engagement there,
that you're providing support
for this new population,
particularly, Steve, when it comes to
coordination of their care, addressing social determinants of
health,
ultimately, how you're how you're thinking about that
as we head into next year.
We've set out at the plan to really
build
a different kind of experience
for our members
by taking advantage
of the services and our ability to to
meaningfully
integrate, not just be owned by
one of the world's best
known,
delivery systems,
Mass General Brigham.
And it was extraordinarily
important to us
to build out the duals product, Jacob, because,
we have over a 100 approximately
a 150,000
Medicaid members right now.
We believe that we have
maybe upwards of close to 20,000
members in that Medicaid pool
who,
might be eligible
for participation
in our duals product, either one k, which
is the 65
product,
or, senior care option, which is the 65
product.
That allows us,
to answer your question directly, it it allows
us to
to provide those members
with additional benefits as well as
giving us the resources
to build a model of care, which is
essential to the actual licensing and filing
of a dual product with both the state
and the federal government
and to use those clinical resources
as well as a bunch of community based
services
to really improve
the experience,
the service package,
and
ultimately
the, you know, not just the health care
experience, but the entire
lifestyle
experience
of those members who we believe are eligible
for dual coverage.
So
this does a couple of things for us.
One, it provides, as I said, a much,
much better opportunity for those members who we
believe are eligible.
And two,
it really is the the crucible. It's the
pressure test
for our ability to work closely with and
integrate with the delivery system
because they're gonna be essential to helping us
support
the care management model.
The third and last leg of the stool
to support,
duals business
is we have a long history
at Mass General of collaborating both on care
and and quite frankly,
from a philanthropy
perspective with
community based providers.
This allows us to build those community based
providers
directly and very intentionally into that,
care model, as I said, to improve the
entire
experience for those members.
This product was extraordinarily
important to this team. We viewed it as
sort of,
you know, essential for us to really
reach the highest levels of what we're trying
to do from a mission perspective.
I've spent twenty five years,
on the board and as an officer of
Boston Health Care for the homeless.
In many ways,
the members at Boston Health Care for the
Homeless typify the kind of members that we'll
be seeing
in the duals product.
In providing sort of that full range of
services,
acute care, community based care,
and community support services to those members
was what we viewed
as an exciting opportunity as well as a
challenge.
Understood. So you're you're thinking that 20,000
potential members could be enrolled in this new
offering, Steve, and and you're really looking to,
reach them with this more enhanced services and
benefits,
for this special population.
You mentioned, earlier on, you know, just the
the strength of Mass General Brigham as a
as a leading integrated care system in this
country, and and we're constantly hearing from from
the system around investments in digital health, in
community based initiatives. So So I'm wondering if
you could share with our listeners,
one or two recent notable examples
from where you sit in terms of where
the the system's investments, the health plans investments
in these spaces have really improved,
the outcomes of your members.
Sure. Wow.
One investment.
In fact, one very key investment, which if
we do it well, should be relatively transparent
to the member, but extraordinarily
important
to,
provider partners
is we have built out and invested in
a digital
care management platform,
which is fully synced up and coordinated with
an identical care management platform
that the delivery systems population health service organization
has provided.
So we essentially
have a window
into the clinical side and they have a
window into
our services, the benefits we can provide,
who's enrolled, when they were enrolled,
how we can look at those members
in a way that a traditional insurance plan
that doesn't have that linkage
with delivery system
cannot.
So, you know, I mentioned that we have
up to 20,000 people in our medicated
right now in our Medicaid ACO
who we think will ultimately be
a qualify for enrollment. And I just wanna
clarify, we don't believe we're gonna get 20,000
members in our initial open enrollment, but
that's the pool that we think we're gonna
be drawing from.
That investment in sort of that mirror care
management system,
we think is gonna
really improve
our ability
to provide
the right service at the right place at
the right time
for our members
because of our ability to look at what's
going on in a real time basis.
That's, you know,
that's a real time
significant investment
where we coordinated our investment with a similar
investment on the delivery system that we think
is gonna pay huge dividends.
In addition to that,
we're working with the delivery system to look
at what we can do on the innovative
side
to develop specific clinically
clinical programs
to support
the specific needs
of the dual membership.
These by and large are members
with complicated health conditions,
many of whom have
behavioral health, you know, substance abuse
diagnosis, as well as clinical programs.
We're looking at, can we provide, an elevated
level of services
on sort of the diabetes obesity issue that
goes well beyond looking at just GLP ones?
Do we build in some specialty obesity
medical services
that, these members will be available,
have available to them?
Do we do the same thing with senior
care on the behavioral health side? We're looking
at building out
a very new and very specific program
which deals with some of the issues that
seniors have in terms of isolation,
loneliness,
and how that impacts their health status,
their mental health status,
and their overall
wellness. We believe that we can dramatically
improve
the health status of those senior members
in our
SCO product
by directly addressing and by directly making services
available
that focus
on those very
prevalent problems related to isolation and loneliness that
we see in the senior market.
We're prioritizing
a stack of services on the women's health
marketplace
to support,
women in these products. And we're looking at
things that we can do
in home health writ large,
which includes home hospital, home health care,
where we can support these members outside of
the hospital setting,
whether it's
doing infusions at home versus the hospital on
sort of the high end of the service
spectrum
or just providing
a series of home services to them, which
can keep them out of the hospital.
But
we're intentionally building out this service package
with the capabilities
of the delivery system in mind to, we
think, provide a higher level of service for
our members.
Absolutely. No. That's so so great in terms
of making these investments now so that these
members in the new year can really take
advantage of your integrated care model. It's it's
amazing.
I wonder, Steve,
I'd be remiss if I didn't ask you
about, of course, it's been a really busy
year when it comes to health care policy,
both on the on the federal and and
state levels.
We, of course, had this this summer, and
everything that happened there with with, HR one
and then, of course, right now with everything
that's going on in in Washington around,
ACA talks. So
just given the broader context of of continually
evolving,
state and federal regulations, I'm wondering how your
participation across multiple insurance markets
really positions you to anticipate this kind of
disruption.
Some of the advantages that you you would
note for us,
that your your product
diversity,
enables you to really stay,
agile across your business model, your care strategies
as you're bringing in new new care models,
how that all works together.
Sure. So
that's where being part of an overall
delivery system, an integrated delivery system and financing
system,
I think gives us
some significant advantages, Jacob.
I think as long as we stay focused
and if I were gonna give any advice
to,
colleagues in similar situations,
as long as we stay focused
on what is ultimately best for our member,
the delivery systems patients.
And that's our North Star.
If we
test everything that we build out and support
against that in our mission
to improve
the health and well-being
of
people in our communities across all of the
product lines, as you've mentioned.
That will continue to focus us
on supporting
a full portfolio of products
where every single member who sees a Mass
General physician
should be able to see
and buy a Mass General Brigham health plan
product
that will support them throughout their life cycle.
So
we're very much focused
on
having the health plan support the core mission
of Mass General Brigham,
which has been around for over two hundred
years
and takes their role as improving
The health
of not only communities in Massachusetts,
but improving the health
of the broader community across this country because
of our research and training
as in teaching as well as what we
do on the direct clinical care side.
So we stay very much focused on that.
That allows us to to deal with the
federal policy piece. And don't get me wrong,
we're spending a huge amount of time
trying to understand not only what's going on
today,
but what the implications of what's going on
today
may mean
for
our members a year from now. Some of
them are gonna lose eligibility.
Some of them going to have to change
the way they access services?
Is there gonna be more debt and free
care in the system, etcetera?
But everything we do
is focused on maintaining as as broad a
level of services and as broad a level
of coverage as we can
for all of those patients because those patients
are in fact our members and we share
sort of a dual responsibility
to provide them with the best packages of
services, both clinical and
from a health insurance perspective that we can.
So
we we approach these policy challenges, and there
are many right now, both on the fund
on the actual funding level,
but just in the level of complexity of
some of the regulatory changes that are going
on.
We approach all of these challenges with
how are we gonna deal with them? How
do we anticipate
maintaining the best support as we can for
our members
as possible?
First,
do we make a decision to stay in
these markets or drop out of these markets?
That's not a decision we're actively contemplating. Jacob,
we're all in right now.
So our goal on a day to day
basis is trying to figure out how to
best provide those services to our members.
Absolutely. Well, in that vein, Steve, and before
we go,
you've got the ears of a lot of
other health plan and industry leaders from all
over the country right now facing the same
or similar challenges that you are. I wonder
what final thoughts or final bits of advice
that you would share with them today.
One is
there's an
what we've talked about puts an incredible demand
on our workforce,
both in the delivery system and at the
health plan.
I think one of the things that's most
incumbent upon
me personally
and my leadership team
is to up the level and the effectiveness
of our communication
with our teams.
They need to understand why we're pivoting,
why we need to
adjust almost constantly to the challenges that are
out there.
So if you think you're doing enough communication
with your teams right now,
I'd say take that level of communication
and multiply it by at least two, and
that should be a goal for the next
year. That you need to
be extraordinarily
focused and extraordinarily
intentional
in terms of providing them with information
about
where the health plan and the system are
going strategically,
what the implications
are for that from an operational basis,
and quite frankly, what the implications are for
that workforce, which is working extraordinarily
hard right now. I can't tell you,
how proud I am of the of of
the response that we've got
from the team at Mass General Brigham health
plan.
In
2020,
we had a relatively small Medicaid
ACO. We're the second largest in the state
right now. We did not have a Medicare
Advantage product.
Our Medicare Advantage product is the fastest growing
one in the state,
and we weren't in the duals marketplace at
all.
They've
dealt with all of the challenges that all
insurers are dealing with as well as growing
in all of those,
market niches over the last few years.
So communication
is extraordinarily important.
Two is just staying focused on mission, as
I said.
As long as we sort of pass
all of our initiatives through the logic filter
of,
does it improve the experience
clinically? Does it improve the
the day to day experience
of the member? Does it improve
the member's
overall well-being?
And does it improve the the health status
of our communities?
If we stay focused on
pushing
sort of
all of our initiatives up against those challenges,
it pretty much tells us where we need
to go right now.
So we have, I I would like to
think
a little less ambivalence
about continuing to grow and quite frankly, continuing
to grow aggressively
into our markets because we believe that's the
only way we can continue to improve the
service levels,
for our members.
So So if I was gonna translate that
into
advice for my colleagues and quite frankly,
I when I meet with my colleagues, I'd
like to try and listen more than
talk because I I learn a lot from
them.
I would say that
you need to be all in, and
you need to be all in across all
the product lines because your members are gonna
be looking for very different things through their
own life cycle.
And I'd like to believe that we're building
an extraordinarily
strong brand
and brand loyalty
for our members
who wanna stay with us over the long
term. I do not believe that you can
sort of have a strategy which shrinks yourself
into success
that we need to continue to adjust and
grow with the market demands that are out
there as complex and as daunting as they
are right now.
Fantastic. I think that's a great last place
to leave things, Steve, so I want to
thank you for taking the time to sit
down with us on the podcast today and
for sharing your insights with our listeners. We
really appreciate it.
Right. Thank you for the time, Jacob. I
appreciate it. Absolutely. And to our listeners, if
you'd like to listen to more podcasts from
Becker's Healthcare, you can visit beckershospitalreview.com.