Latest / Becker’s Payer Issues Podcast / Steve Tringale, President of Mass General Brigham Health Plan

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Steve Tringale, President of Mass General Brigham Health Plan · Becker’s Payer Issues Podcast

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Hello, everyone. This is Jacob Emerson with the
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Becker's Payer Issues podcast. Thrilled today to be
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joined by Steve Tringale, who is the president
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of Mass General Brigham Health Plan. Steve, thanks
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so much for taking the time to be
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with me on the podcast today. Thanks, Jacob.
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I am, Steve Tringale. I've been president
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of Mass General Brigham's health plan
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since
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2000.
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I have over
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thirty years experience
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working with both health systems and health plans
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as both
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the lead consultant
0:35
and as
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a business strategist
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as well as having operational
0:41
responsibility
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for major product lines,
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not only at Mass General Brigham, but in
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a prior stop with a different carrier in
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my earlier career.
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I was asked in 2020
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to come in
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into build out a vision for Mass General
1:00
Brigham's health plan,
1:02
which included a full product line portfolio
1:06
so that every member who is
1:10
using a Mass General
1:12
Brigham provider can find a Mass General Brigham
1:15
health plan product
1:16
that will support,
1:19
their journey through the health care system. So
1:22
we have taken that
1:23
and our focus on the members sort of
1:25
our North Star and
1:28
have built out a full product portfolio,
1:31
which includes commercial products,
1:33
Medicare Advantage,
1:35
a
1:36
very large, in fact, the second largest Medicaid
1:39
ACO,
1:40
in the Commonwealth Of Massachusetts,
1:43
and now,
1:45
dual eligible products in both the 65
1:48
and the 65
1:49
market. So we have pretty much rounded out
1:52
a full portfolio at the plan.
1:54
Right. And let's stay on the topic of
1:56
of the dual eligible special special needs plans.
1:59
You announced earlier this year that you're planning
2:01
to enter that space in in 2026.
2:04
So talk to us a little bit about
2:06
why the the health plan made this decision
2:08
and, ultimately, how you're building on your existing
2:11
Medicaid experience, serving that population to really ensure
2:14
that there's meaningful engagement there,
2:16
that you're providing support
2:18
for this new population,
2:20
particularly, Steve, when it comes to
2:22
coordination of their care, addressing social determinants of
2:26
health,
2:27
ultimately, how you're how you're thinking about that
2:28
as we head into next year.
2:31
We've set out at the plan to really
2:33
build
2:35
a different kind of experience
2:38
for our members
2:40
by taking advantage
2:42
of the services and our ability to to
2:45
meaningfully
2:46
integrate, not just be owned by
2:49
one of the world's best
2:51
known,
2:52
delivery systems,
2:53
Mass General Brigham.
2:55
And it was extraordinarily
2:57
important to us
2:59
to build out the duals product, Jacob, because,
3:04
we have over a 100 approximately
3:07
a 150,000
3:08
Medicaid members right now.
3:11
We believe that we have
3:14
maybe upwards of close to 20,000
3:17
members in that Medicaid pool
3:20
who,
3:21
might be eligible
3:22
for participation
3:24
in our duals product, either one k, which
3:27
is the 65
3:28
product,
3:29
or, senior care option, which is the 65
3:32
product.
3:34
That allows us,
3:36
to answer your question directly, it it allows
3:39
us to
3:40
to provide those members
3:43
with additional benefits as well as
3:46
giving us the resources
3:49
to build a model of care, which is
3:51
essential to the actual licensing and filing
3:55
of a dual product with both the state
3:58
and the federal government
3:59
and to use those clinical resources
4:02
as well as a bunch of community based
4:04
services
4:05
to really improve
4:07
the experience,
4:09
the service package,
4:12
and
4:13
ultimately
4:14
the, you know, not just the health care
4:17
experience, but the entire
4:20
lifestyle
4:21
experience
4:22
of those members who we believe are eligible
4:26
for dual coverage.
4:27
So
4:29
this does a couple of things for us.
4:30
One, it provides, as I said, a much,
4:32
much better opportunity for those members who we
4:35
believe are eligible.
4:37
And two,
4:38
it really is the the crucible. It's the
4:40
pressure test
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for our ability to work closely with and
4:44
integrate with the delivery system
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because they're gonna be essential to helping us
4:49
support
4:50
the care management model.
4:52
The third and last leg of the stool
4:55
to support,
4:56
duals business
4:58
is we have a long history
5:01
at Mass General of collaborating both on care
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and and quite frankly,
5:08
from a philanthropy
5:10
perspective with
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community based providers.
5:15
This allows us to build those community based
5:17
providers
5:19
directly and very intentionally into that,
5:22
care model, as I said, to improve the
5:24
entire
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experience for those members.
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This product was extraordinarily
5:30
important to this team. We viewed it as
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sort of,
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you know, essential for us to really
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reach the highest levels of what we're trying
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to do from a mission perspective.
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I've spent twenty five years,
5:44
on the board and as an officer of
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Boston Health Care for the homeless.
5:48
In many ways,
5:50
the members at Boston Health Care for the
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Homeless typify the kind of members that we'll
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be seeing
5:55
in the duals product.
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In providing sort of that full range of
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services,
6:00
acute care, community based care,
6:03
and community support services to those members
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was what we viewed
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as an exciting opportunity as well as a
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challenge.
6:12
Understood. So you're you're thinking that 20,000
6:16
potential members could be enrolled in this new
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offering, Steve, and and you're really looking to,
6:21
reach them with this more enhanced services and
6:24
benefits,
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for this special population.
6:27
You mentioned, earlier on, you know, just the
6:30
the strength of Mass General Brigham as a
6:32
as a leading integrated care system in this
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country, and and we're constantly hearing from from
6:38
the system around investments in digital health, in
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community based initiatives. So So I'm wondering if
6:43
you could share with our listeners,
6:44
one or two recent notable examples
6:47
from where you sit in terms of where
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the the system's investments, the health plans investments
6:52
in these spaces have really improved,
6:54
the outcomes of your members.
6:57
Sure. Wow.
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One investment.
7:00
In fact, one very key investment, which if
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we do it well, should be relatively transparent
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to the member, but extraordinarily
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important
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to,
7:10
provider partners
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is we have built out and invested in
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a digital
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care management platform,
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which is fully synced up and coordinated with
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an identical care management platform
7:27
that the delivery systems population health service organization
7:31
has provided.
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So we essentially
7:35
have a window
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into the clinical side and they have a
7:40
window into
7:41
our services, the benefits we can provide,
7:45
who's enrolled, when they were enrolled,
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how we can look at those members
7:49
in a way that a traditional insurance plan
7:53
that doesn't have that linkage
7:56
with delivery system
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cannot.
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So, you know, I mentioned that we have
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up to 20,000 people in our medicated
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right now in our Medicaid ACO
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who we think will ultimately be
8:09
a qualify for enrollment. And I just wanna
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clarify, we don't believe we're gonna get 20,000
8:14
members in our initial open enrollment, but
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that's the pool that we think we're gonna
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be drawing from.
8:21
That investment in sort of that mirror care
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management system,
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we think is gonna
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really improve
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our ability
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to provide
8:33
the right service at the right place at
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the right time
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for our members
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because of our ability to look at what's
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going on in a real time basis.
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That's, you know,
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that's a real time
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significant investment
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where we coordinated our investment with a similar
8:51
investment on the delivery system that we think
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is gonna pay huge dividends.
8:56
In addition to that,
8:58
we're working with the delivery system to look
9:00
at what we can do on the innovative
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side
9:03
to develop specific clinically
9:05
clinical programs
9:07
to support
9:09
the specific needs
9:11
of the dual membership.
9:13
These by and large are members
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with complicated health conditions,
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many of whom have
9:20
behavioral health, you know, substance abuse
9:24
diagnosis, as well as clinical programs.
9:27
We're looking at, can we provide, an elevated
9:31
level of services
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on sort of the diabetes obesity issue that
9:35
goes well beyond looking at just GLP ones?
9:39
Do we build in some specialty obesity
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medical services
9:44
that, these members will be available,
9:47
have available to them?
9:50
Do we do the same thing with senior
9:52
care on the behavioral health side? We're looking
9:55
at building out
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a very new and very specific program
10:01
which deals with some of the issues that
10:03
seniors have in terms of isolation,
10:06
loneliness,
10:07
and how that impacts their health status,
10:11
their mental health status,
10:13
and their overall
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wellness. We believe that we can dramatically
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improve
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the health status of those senior members
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in our
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SCO product
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by directly addressing and by directly making services
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available
10:30
that focus
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on those very
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prevalent problems related to isolation and loneliness that
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we see in the senior market.
10:38
We're prioritizing
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a stack of services on the women's health
10:43
marketplace
10:44
to support,
10:46
women in these products. And we're looking at
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things that we can do
10:51
in home health writ large,
10:53
which includes home hospital, home health care,
10:56
where we can support these members outside of
10:59
the hospital setting,
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whether it's
11:02
doing infusions at home versus the hospital on
11:05
sort of the high end of the service
11:08
spectrum
11:09
or just providing
11:10
a series of home services to them, which
11:13
can keep them out of the hospital.
11:15
But
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we're intentionally building out this service package
11:20
with the capabilities
11:21
of the delivery system in mind to, we
11:24
think, provide a higher level of service for
11:27
our members.
11:28
Absolutely. No. That's so so great in terms
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of making these investments now so that these
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members in the new year can really take
11:35
advantage of your integrated care model. It's it's
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amazing.
11:38
I wonder, Steve,
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I'd be remiss if I didn't ask you
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about, of course, it's been a really busy
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year when it comes to health care policy,
11:45
both on the on the federal and and
11:47
state levels.
11:48
We, of course, had this this summer, and
11:51
everything that happened there with with, HR one
11:54
and then, of course, right now with everything
11:55
that's going on in in Washington around,
11:58
ACA talks. So
12:00
just given the broader context of of continually
12:03
evolving,
12:04
state and federal regulations, I'm wondering how your
12:07
participation across multiple insurance markets
12:10
really positions you to anticipate this kind of
12:12
disruption.
12:13
Some of the advantages that you you would
12:15
note for us,
12:16
that your your product
12:19
diversity,
12:20
enables you to really stay,
12:24
agile across your business model, your care strategies
12:26
as you're bringing in new new care models,
12:30
how that all works together.
12:32
Sure. So
12:34
that's where being part of an overall
12:37
delivery system, an integrated delivery system and financing
12:40
system,
12:41
I think gives us
12:44
some significant advantages, Jacob.
12:47
I think as long as we stay focused
12:49
and if I were gonna give any advice
12:51
to,
12:52
colleagues in similar situations,
12:54
as long as we stay focused
12:56
on what is ultimately best for our member,
13:00
the delivery systems patients.
13:02
And that's our North Star.
13:05
If we
13:06
test everything that we build out and support
13:08
against that in our mission
13:11
to improve
13:13
the health and well-being
13:15
of
13:16
people in our communities across all of the
13:18
product lines, as you've mentioned.
13:21
That will continue to focus us
13:24
on supporting
13:26
a full portfolio of products
13:29
where every single member who sees a Mass
13:31
General physician
13:33
should be able to see
13:36
and buy a Mass General Brigham health plan
13:39
product
13:40
that will support them throughout their life cycle.
13:44
So
13:45
we're very much focused
13:47
on
13:48
having the health plan support the core mission
13:50
of Mass General Brigham,
13:52
which has been around for over two hundred
13:54
years
13:56
and takes their role as improving
14:00
The health
14:01
of not only communities in Massachusetts,
14:04
but improving the health
14:06
of the broader community across this country because
14:09
of our research and training
14:12
as in teaching as well as what we
14:14
do on the direct clinical care side.
14:16
So we stay very much focused on that.
14:20
That allows us to to deal with the
14:23
federal policy piece. And don't get me wrong,
14:24
we're spending a huge amount of time
14:27
trying to understand not only what's going on
14:29
today,
14:30
but what the implications of what's going on
14:32
today
14:33
may mean
14:34
for
14:35
our members a year from now. Some of
14:37
them are gonna lose eligibility.
14:39
Some of them going to have to change
14:41
the way they access services?
14:44
Is there gonna be more debt and free
14:46
care in the system, etcetera?
14:48
But everything we do
14:50
is focused on maintaining as as broad a
14:53
level of services and as broad a level
14:55
of coverage as we can
14:57
for all of those patients because those patients
15:01
are in fact our members and we share
15:03
sort of a dual responsibility
15:05
to provide them with the best packages of
15:07
services, both clinical and
15:10
from a health insurance perspective that we can.
15:13
So
15:15
we we approach these policy challenges, and there
15:18
are many right now, both on the fund
15:21
on the actual funding level,
15:23
but just in the level of complexity of
15:25
some of the regulatory changes that are going
15:27
on.
15:28
We approach all of these challenges with
15:31
how are we gonna deal with them? How
15:33
do we anticipate
15:34
maintaining the best support as we can for
15:36
our members
15:38
as possible?
15:39
First,
15:40
do we make a decision to stay in
15:42
these markets or drop out of these markets?
15:44
That's not a decision we're actively contemplating. Jacob,
15:48
we're all in right now.
15:50
So our goal on a day to day
15:51
basis is trying to figure out how to
15:53
best provide those services to our members.
15:56
Absolutely. Well, in that vein, Steve, and before
15:59
we go,
16:00
you've got the ears of a lot of
16:01
other health plan and industry leaders from all
16:04
over the country right now facing the same
16:07
or similar challenges that you are. I wonder
16:10
what final thoughts or final bits of advice
16:13
that you would share with them today.
16:16
One is
16:17
there's an
16:19
what we've talked about puts an incredible demand
16:24
on our workforce,
16:25
both in the delivery system and at the
16:27
health plan.
16:29
I think one of the things that's most
16:30
incumbent upon
16:32
me personally
16:33
and my leadership team
16:36
is to up the level and the effectiveness
16:39
of our communication
16:41
with our teams.
16:43
They need to understand why we're pivoting,
16:46
why we need to
16:47
adjust almost constantly to the challenges that are
16:50
out there.
16:51
So if you think you're doing enough communication
16:54
with your teams right now,
16:56
I'd say take that level of communication
16:59
and multiply it by at least two, and
17:01
that should be a goal for the next
17:03
year. That you need to
17:05
be extraordinarily
17:07
focused and extraordinarily
17:09
intentional
17:10
in terms of providing them with information
17:12
about
17:13
where the health plan and the system are
17:15
going strategically,
17:17
what the implications
17:18
are for that from an operational basis,
17:21
and quite frankly, what the implications are for
17:23
that workforce, which is working extraordinarily
17:26
hard right now. I can't tell you,
17:30
how proud I am of the of of
17:32
the response that we've got
17:34
from the team at Mass General Brigham health
17:36
plan.
17:37
In
17:38
2020,
17:40
we had a relatively small Medicaid
17:42
ACO. We're the second largest in the state
17:44
right now. We did not have a Medicare
17:47
Advantage product.
17:49
Our Medicare Advantage product is the fastest growing
17:52
one in the state,
17:53
and we weren't in the duals marketplace at
17:55
all.
17:56
They've
17:57
dealt with all of the challenges that all
18:00
insurers are dealing with as well as growing
18:03
in all of those,
18:05
market niches over the last few years.
18:07
So communication
18:08
is extraordinarily important.
18:12
Two is just staying focused on mission, as
18:14
I said.
18:15
As long as we sort of pass
18:18
all of our initiatives through the logic filter
18:20
of,
18:21
does it improve the experience
18:23
clinically? Does it improve the
18:27
the day to day experience
18:29
of the member? Does it improve
18:31
the member's
18:32
overall well-being?
18:34
And does it improve the the health status
18:36
of our communities?
18:38
If we stay focused on
18:40
pushing
18:41
sort of
18:43
all of our initiatives up against those challenges,
18:47
it pretty much tells us where we need
18:49
to go right now.
18:51
So we have, I I would like to
18:54
think
18:54
a little less ambivalence
18:57
about continuing to grow and quite frankly, continuing
19:01
to grow aggressively
19:03
into our markets because we believe that's the
19:05
only way we can continue to improve the
19:07
service levels,
19:08
for our members.
19:10
So So if I was gonna translate that
19:12
into
19:13
advice for my colleagues and quite frankly,
19:17
I when I meet with my colleagues, I'd
19:20
like to try and listen more than
19:22
talk because I I learn a lot from
19:24
them.
19:25
I would say that
19:27
you need to be all in, and
19:31
you need to be all in across all
19:33
the product lines because your members are gonna
19:35
be looking for very different things through their
19:37
own life cycle.
19:38
And I'd like to believe that we're building
19:40
an extraordinarily
19:42
strong brand
19:43
and brand loyalty
19:45
for our members
19:47
who wanna stay with us over the long
19:49
term. I do not believe that you can
19:51
sort of have a strategy which shrinks yourself
19:53
into success
19:55
that we need to continue to adjust and
19:57
grow with the market demands that are out
20:00
there as complex and as daunting as they
20:02
are right now.
20:04
Fantastic. I think that's a great last place
20:06
to leave things, Steve, so I want to
20:08
thank you for taking the time to sit
20:10
down with us on the podcast today and
20:11
for sharing your insights with our listeners. We
20:14
really appreciate it.
20:16
Right. Thank you for the time, Jacob. I
20:17
appreciate it. Absolutely. And to our listeners, if
20:20
you'd like to listen to more podcasts from
20:22
Becker's Healthcare, you can visit beckershospitalreview.com.