← Becker’s Healthcare Podcast
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- [00:00]
A
Hello everyone. This is Jacob Emerson with the Becker's Payer Issues podcast. Thrilled today to be joined by Steve Tringali, 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.
- [00:13]
B
Thanks, Jacob. I am Steve Tringale. I've been president of Mass General Brigham's health plan since 2000. I have over 30 years experience working with both health systems and health plans as both a 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 and to 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 in our focus on the member as 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 under 65 and the over 65 market. So we have pretty much rounded out a full portfolio at the plan.
- [01:55]
A
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.
- [02:31]
B
We've set out at the plan to really build a different kind of experience for our members by taking advantage of, 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 100, approximately 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, care, which is the under 65 product, or senior care option, which is the over 65 product that allows us to answer your question directly. It allows us 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 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 crucible. It's the pressure test for our ability to work closely with and integrate with the delivery system because they're going to 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 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 25 years on the board and as an officer of Boston Healthcare for the Homeless. In many ways, the members at Boston Healthcare for the Homeless typify the kind of members that we 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.
- [06:13]
A
Understood. So you're thinking that 20,000 members, potential members, could be enrolled in this new offering, Steve, 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 I'm wondering if you could share with our listeners 1 or 2 recent notable examples from it in terms of where the, the systems investments, the health plans investments in these spaces have really improved the outcomes of your members.
- [06:57]
B
Sure. Well, 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 our 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're 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 Medicaid pool right now in our Medicaid ACO who we think will ultimately be qualify for enrollment. And I just want to clarify, we don't believe we're going to get 20,000 members in our initial open enrollment, but that's the pool that we think we're going to be drawing from. That investment in sort of that mirror care management system we think is going to 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 going to 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 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, substance abuse diagnoses as well as clinical programs. We're looking at can we provide an elevated level of services on sort of the diabesity obesity issue that goes well beyond looking at just GLP1s. 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 in 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.
- [11:29]
A
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 healthcare policy, both on the, on the federal and state levels. We of course had this this summer and everything that happened there with, with HR1 and of course right now with everything that's going on in Washington around ACA talks. So just given the broader context 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 would note for us, that 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.
- [12:33]
B
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 going to 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 200 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 and 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 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 members a year from now. Some of them going to lose eligibility, some of them going to have to change the way they access services, is there going to be more debt and free care in the system, et cetera. But everything we do is focused on maintaining 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 going to 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.
- [15:57]
A
Absolutely. Well, 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.
- [16:16]
B
One is there's an incre. What we've talked about puts an incredible demand on, 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 your 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 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 day to day experience of the member, does it improve the members overall well being and does it improve 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 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 if I was going to translate that into advice for my colleagues and quite frankly when I meet with my colleagues I like to try and listen more than talk because 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 going to 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 in brand loyalty for our members who want to 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.
- [20:04]
A
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.
- [20:16]
B
Right. Thank you for the time, Jacob. I appreciate it.
- [20:19]
A
Absolutely. And to our listeners, if you'd like to listen to more podcasts from Becker's Healthcare, you can visit Beckershospitalreview.com.