In 2026, some health system-owned insurance plans have continued to face headwinds.
Renton, Wash.-based Providence is slated to close most of its insurance business, Providence Health Plan, starting in 2027. Plans operated by Urbana, Ill.-based Carle Health and Ann Arbor-based Michigan Medicine, for example, have also wound down recently. But not all health plans have the same narrative.
Following its 2025 earnings report, Detroit-based Henry Ford Health told Becker’s the plan had its largest membership base in recent history. Timed to its 40 years of integration, the plan recently modified its branding from HAP to Health Alliance Plan by Henry Ford Health. After the announcement, Health Alliance Plan President Margaret Anderson said on the “Becker’s Payer Issues Podcast” that the insurance arm serves about 510,000 members across Michigan’s Lower Peninsula.
Becker’s also recently heard from Mass General Brigham Health Plan President Steve Tringale. The health plan for Somerville, Mass.-based Mass General Brigham was one factor driving the system’s $22.8 billion fiscal 2025 operating revenue, up 11% year over year.
The two leaders painted a picture of what it takes to run a thriving integrated health plan.
Defined goals and mission alignment
Payers and providers have “natural misalignment,” Ms. Anderson said. She emphasized the importance of shared goals, such as working toward high Medicare Advantage star ratings, that could uplift both sides of the organization.
“People get better outcomes, better access to quality care,” she said. “It helps the provider side. It helps the plan side.”
The rebrand’s news release addressed Health Alliance Plan’s Henry Ford Health Select plan, tailored for patients already in the Henry Ford Health system, calling it “a recent example of care informing coverage.” The organization said Michigan employers saw roughly 15% lower premiums and more connected care journeys.
Mass General’s Mr. Tringale called for mission-level, not just operational, alignment. Otherwise, the underlying tensions that can exist between freestanding payers and providers may “rear its head in the same way with integrated systems, and you’re going to see less than optimal performance.”
“The mission and then the vision was to make sure that everyone who accesses Mass General Brigham can find a product in Mass General Brigham Health Plan that will serve their needs from cradle to grave,” he said.
Integration from the get-go is not what necessarily makes or breaks an integrated plan, Mr. Tringale said. Longtime integration “has historical significance,” but, regardless of the history, he encourages a forward-looking perspective.
Mr. Tringale said Mass General Brigham does not make decisions based entirely on health plan performance or membership targets, instead considering the plan as part of the bigger picture. At the same time, the health plan still has to carry out the functions of traditional insurers, such as risk adjustment and utilization management.
“We also need to make sure that we have highly functioning, quick escalation models to make sure that both members and providers understand what their position is and what they need to do to access the care that they need,” he said. “Those are things that are sort of table stakes.”
Scale
Mr. Tringale broke down two ways plans should think about growth, the first being the product lineup. He cautioned that some plans are dealing with concentration risk with their offerings and client base.
“When you run a plan that has only one or two product lines or has one or two customers, there’s an inherent amount of risk related to the volatility in that individual relationship,” he said.
Mr. Tringale also addressed membership.
“Performance-based contracting works best when you have actuarially sound pools, and actuarially sound pools require membership,” Mr. Tringale said. “It is much more difficult for really small plans.”
Fallon Health plans to join Mass General Brigham Health Plan, according to a January joint statement. More broadly, Mr. Tringale said that to strengthen performance-based contracting, acquiring additional insurance plans and members through product lines “gives you that ability to do performance-based contracting across a broader spectrum of your provider relationships.”
Cost and discipline
While Health Alliance Plan is aiming to grow membership to 750,000, Ms. Anderson underscored the balance between growth and bandwidth.
“As we grow, we need to hold the tension around capacity and adding too much capacity to the plan,” she said.
Health Alliance Plan’s administrative loss ratio is down to less than 10.5%, the lowest it has been since 2013, she said. One step the plan took to mitigate administrative costs was moving customer service centers back onshore, something Ms. Anderson acknowledged may sound counterintuitive.
“It was actually costing us more money when you looked at the complaints we were getting in, some potential compliance concerns,” she said. “That’s created a differentiator for us where people can talk to somebody that actually lives in the state of Michigan [and] can actually understand what their needs are and how they might be unique.”
There are still cost concerns on the horizon, like identifying mechanisms to fund expensive gene therapies, she said.
For Mr. Tringale, individual member outcomes are the main lever for affordability and trend management.
“If we can improve members’ outcomes at the individual level, and we can improve the health status of the populations that we serve … that’s really the long-term differentiator for the plan,” Mr. Tringale said. “But more importantly, that’s the pathway to long-term stability and success as an integrated payer-provider entity.”
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.