Becker’s Healthcare Podcast · 2026-11-01 · 9 min
Key moments - from our scoring
Substance score
27 / 100
Five dimensions, 20 points each
Mass General Brigham Health Plan, a 40-year-old nonprofit serving over 420,000 members across commercial, Medicare Advantage, Medicaid, and dual-eligible lines, is responding to acute employer affordability concerns by launching a Value HMO targeted at large regional employers. Jennifer Saint Thomas, SVP of Commercial and Medicare Markets, explains the product addresses employer feedback about rising healthcare costs compounded by broader inflation, while preserving employee retention benefits through maintained access to quality institutions. The Value HMO works alongside their existing Complete Access EPO (launched two years ago for nationwide remote workforces) to serve different employer segments. Best suited for organizations with concentrated Greater Boston-area workforces - municipalities, schools, colleges, universities - the Value HMO includes breadth across preeminent systems (Mass General Brigham, Beth Israel, Boston Medical Center, South Shore Hospital) across eight Massachusetts counties. Saint Thomas emphasizes that affordability pressures are driving some employers to explore alternatives to group insurance like Individual Coverage Health Reimbursement Arrangements (ICRAs), making innovative solutions critical to keeping the group market viable. Future expansion hinges on finding willing partner networks that meet regulatory adequacy requirements.
Hosted by Becker's Healthcare. The show scores 69.4/100 on substance across its analysed episodes. See the full show profile.
The Value HMO is a local HMO offering designed for large employer groups concentrated in the Boston and surrounding Metro Boston area, providing a lower-cost alternative while maintaining access to major health systems like Mass General Brigham and Beth Israel Leahy. It is best suited for employers in municipalities, schools, colleges, and universities where the workforce is predominantly local to the eight-county Massachusetts service area.
Employers and members have identified rising healthcare costs combined with general inflation as their top concern, prompting them to seek new, more affordable solutions. Simultaneously, some employers are exploring alternatives to group insurance entirely, making innovation on affordability critical for plans to keep the group insurance marketplace viable.
The Complete Access EPO, launched two years ago, is a nationwide product designed for employers with remote workforces, offering significant savings over PPO plans. The Value HMO drives deeper affordability specifically for employers with concentrated employees in the Greater Boston area, complementing rather than replacing the broader network EPO offering.
The Value HMO network includes preeminent systems such as Mass General Brigham, Beth Israel Leahy, Boston Medical Center, and community hospitals like South Shore Hospital, providing breadth across eight Massachusetts counties.
Yes, the plan is open to expansion in the future but will only expand where there are willing partnerships with providers that allow them to meet network adequacy requirements and align with population concentration patterns.
Our reviewer’s read on each dimension, with quotes from the episode.
The episode is essentially a product launch press release read aloud; nearly every claim is generic (affordability is rising, employers want options, relationships matter). The single mildly actionable data point - that brokers are increasingly quoting ICHRAs - is dropped and never explored.
really the rising health care costs that are also being impacted by the just general inflation that's happening across the rest of their business really has become their their top concern
I think the other advice, I would leave people with is just as someone that's worked here locally at nonprofit plans, just the importance of relationships
No contrarian or first-principles thinking anywhere in the episode; every frame (affordability pressure, listening to the market, relationships during hard cycles) is a standard health-plan talking point recycled verbatim. There is no novel argument or counterintuitive claim.
we really pride ourselves on being a listening organization
really being able to double down on those relationships, and those honest and transparent conversations, whether it be with providers, with brokers, with employers
Jennifer Saint Thomas holds genuine P&L responsibility as SVP of Commercial and Medicare Markets at a large regional nonprofit plan and has real practitioner experience across sales, account management, and provider contracting - legitimately qualified - but the substance she shares in this episode is almost entirely promotional.
My role at the plan is overseeing the commercial and the Medicare lines of business, which includes functional responsibility for sales and product as well as the financial, profit and loss responsibility
A handful of concrete details exist (420,000 members, eight counties, named hospitals, a two-year-old EPO launch) but there are zero cost-savings figures, no premium comparisons, no enrollment projections, and no utilization data for the new product being discussed.
We have over 420,000 members that are spread across four different business lines
two years ago, we launched a very popular complete access EPO, which was essentially a nationwide HMO chassis type product that was able to provide, pretty significant savings compared to PPO plans
The host asks predictable, leading questions and accepts every answer without probing for numbers or mechanism; the one genuine follow-up (on ICHRA alternatives) was a good instinct but was immediately dropped when the guest gave a vague non-answer.
When you say alternatives to group insurance, what are you hearing from brokers?
I mean, you have brokers really, I think, quoting, ICRA or were they calling it your choice now, I think, in a far higher rate than than previously
Computed from the transcript - who did the talking, and the words that came up most.
In this episode, Jennifer St. Thomas, SVP Commercial and Medicare Markets at Mass General Brigham Health Plan, discusses the plan’s new Value HMO offering for large employers, designed to lower healthcare costs while preserving access to leading regional health systems.
Transcribed and scored by The B2B Podcast Index.
- Hi, everyone. This is Elizabeth Cassello with the - Becker's Payer Issues podcast. - I'm excited today to be joined by Jennifer - Saint Thomas, SVP of commercial and Medicare markets - at Mass General Brigham health plan. Jennifer, thank - you so much for taking the time to - chat with us today.
- Thank you for having me. Appreciate it. - Of course. And I would love to hear - a little bit more about yourself and your - career background and your current role at Mass - General Brigham Health Plan.
- Absolutely. And I will also - introduce who Mass General Brigham Health Plan is, - for people that might not be familiar. - We are a nonprofit health plan that was - founded forty years ago by - community based organizations - right here in Boston, Massachusetts. - We have over 420,000 - members - that are spread across four different business lines - for commercial, Medicare Advantage, Medicaid, - and the duals.
- And, really, our our core value proposition - is to focus on deeper integration - with Mass General Brigham, which is one of - the largest provider systems in New England, - to improve outcomes, manage costs, and really create - that end to end seamless health care experience. - My role at the plan is overseeing the - commercial and the Medicare lines of business, - which includes functional responsibility - for sales and product as well as the - financial, - profit and loss responsibility.
- And the vast majority of my year has... - My career has really been at highly regarded - local nonprofit health plans, and I've had a - range of roles from sales to account management - to provider contract negotiation. - Well, Jennifer, thank you for giving us that - background. And I know one thing that we're - excited to chat about today is your team - recently launching a value HMO for large employers.
- So maybe before we get into some of - the details about that, would you mind giving - a high level overview - of what that offering is? - Absolutely. - So the Value HMO plan, - is a local offering, - and it's really best suited for large employer - groups that are concentrated - in the Boston area and the surrounding sort - of Metro Boston area, - really looking for a lower cost alternative - while still retaining access to well regarded institutions - such as Mass General Brigham, - Beth Israel Leahy.
- So we're we're excited to be able to - bring this new product offering. - It's really also addressing the need for affordability - right now in the marketplace. - Yeah. So I was gonna ask why now.
- I mean, I can imagine there are a - lot of affordability pressures that were coming to - mind as this offering was being created. Could - you elaborate a little bit more on that? - Absolutely. So we, you know, we really pride - ourselves on being a listening organization, and we've - been hearing from employers and members that - really the rising health care costs - that are also being impacted by - the just general inflation that's happening across the - rest of their business - really has become their their top concern.
And - so they're looking at new solutions. They're looking - to be, - be creative. - And so we really are creating this product - to address that issue, but in a way - that's practical, that's still providing meaningful access so - that people can retain their employees because we're - still hearing - that retention - of employees is is really critical for employers - as well. - Is there interest in offering - this alongside broader network offerings?
- There is. And I think that's that's an - important component of the strategy is that we - are going to continue to offer - our full network commercial products with access to - a broader range of primary and specialty care, - that offering alongside - of the new value HMO. And so, - two years ago, we launched a very popular - complete access - EPO, which was essentially - a nationwide - HMO chassis type product that was able to - provide, - pretty significant savings compared to PPO plans, - which had been the only option for employers - that had a remote workforce.
- So this complements that nicely where you're able - to have - that more affordable solution - for employers that are... Want that nationwide access, - but then driving a deeper level of affordability, - particularly when you have a concentration - of employees in the Greater Boston area. - And so with the value HMO that's new, - are there certain types of large employers that - this might be best suited for, or do - you see, - a pretty broad swath being interested who are - in the area?
- We are seeing that employers that have that - concentration - of employees in the Greater Boston area - as being the best suited. So you think - about verticals like municipalities, - local schools, colleges, - universities, where you do have, - the predominance of employees being local local here - and really residing here. - We are in eight counties, - that, again, follow that same kind of concentration - of population here in Massachusetts. - So we think it's gonna be a fit, - also because of the breadth of the network - that the value HMO has.
You know, I - mentioned, - you know, preeminent... - Other preeminent, - systems like Beth Israel, like Boston Medical Center, - like, obviously, Mass General Brigham, as well as - some really well known community hospitals like South - Shore Hospital are included in the network. - I know you mentioned the counties that y'all - are starting with. Do you think there's a - possibility of further expansion, or is it more - just focused on where that concentration currently is?
- We are absolutely open to expanding this in - the future. - You know, it's really about finding those willing - partnerships that would allow us to expand into - other counties and meet, - the network adequacy requirements. - But we, - we absolutely think we have a strong start - here with the eight counties that that we're - offering this in and a really nice overlap - with, again, that concentration of population that exists - here in Massachusetts. - And I would love to hear at a - higher level, what is the biggest trend defining - commercial markets, you know, whether that be employer - or just thinking more broadly about commercial markets - this upcoming year that insurers may be underestimating?
- I mean, it's hard to say that insurers - are underestimating it, but I I have to - go back to affordability. It's just such a - pressing issue, particularly at a time - where health insurance increases - are at a higher level, you know, than - we had seen previously, really driven by - higher utilization. - And so, you know, we... Again, this is - something that as I talk to brokers in - my community, - I hear time and again that they're really - looking at even some alternatives to group insurance.
- And so - that's really putting, - I think, pressure on us as plans to - come up with solutions - that can keep the group insurance marketplace - viable, and and I think the value HMO - is is really helping us get there. - When you say alternatives to group insurance, - what are you hearing from brokers? - I mean, you have brokers really, I think, - quoting, - ICRA or were they calling it your choice - now, I think, in a far higher rate - than than previously. - So...
And I think they're... They feel like - the market conditions are really what's what's forcing - that right now. - That makes a lot of sense. Do you - have any final thoughts or other advice for - leaders in the industry?
- I think the other advice, - I would leave people with is just as - someone that's worked here locally at nonprofit plans, - just the importance of relationships. - And, really, you know, when you're in a - difficult performance cycle, really being able to to - double down on - those relationships, - and those honest and transparent conversations, - whether it be with providers, with brokers, with - employers. And so, - I know our team at The Plan, we - really pride ourselves - on our local background and our ability to - connect.
And, you know, in this increasingly - virtual environment, it's just so so important that - we do that. - Well, Jennifer, thank you so much for taking - the time to chat with us today. - Thanks for having me, Elizabeth. I appreciate it.
- Of course. And to our listeners, if you'd - like to hear more podcasts from Becker's HealthCare, - you can visit beckershospitalreview.com. - Thank you.
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