Medicaid Who’s Who Interview: Tommy Duncan

Tommy Duncan is CEO of Trusted Health Plans, Inc.

Check out his LinkedIn profile HERE.
Which segment of the industry are you currently involved?

I am the CEO of Trusted Health Plans, Inc. a Medicaid MCO with plans in Washington, DC, and Michigan.

How many years have you been in the Medicaid industry?

I have been in the industry for 10 years, however, have been exposed to the industry since childhood. My mother ran a health plan.

What is your focus/passion? (Industry related or not)

At my core, I always want to leave things better than I found them. I want to use whatever talents I have been blessed with to have a positive impact in my personal and professional endeavors. At this point in my career, that means focusing on how Trusted Health Plans can leverage its size and resources to have a meaningful and quantifiable positive impact on the overall quality and outcomes of the American healthcare system. Specifically, how can we partner at the local and national level with other leaders to address the social determinants of health that greatly influence quality of life and overall health for our Medicaid members.

My focus is on Fixing Medicaid’s cost trajectory. Medicaid has a serious cost problem that will soon surpass $1,000,000,000,000 Annually.

Policymakers have continuously failed to address the causes of this problem. Instead of taking the difficult path to find solutions that truly reduce the cost of healthcare, (which is the only way to reduce and control Medicaid spending), we put programs and policies into place following an easy path. These policies and programs never address the problem of increasing cost of care, but rather, temporarily, reduce Medicaid spending by decreasing eligibility, either through reductions in benefits or restrictions like work requirements or drug testing.

Sadly, these attacks on eligibility don’t decrease true costs; they shift the costs to different areas within the budget.

Sick people will still need access to care. With or without Medicaid those in need will see the treatment needed. Treatment usually occurs in the emergency department at a hospital, which is the most expensive cost of entry into healthcare. By law, the hospitals will have to treat the individuals without insurance. Eventually, these treatments stress the hospitals budget to the point of requiring the State to aid them and keep them open. The State will either take dollars from another area in the “budget pie,” perhaps from Education or will raise the sales tax and or income tax. Either way, taxpayers, their families, and the State loses.

The only way to control the Medicaid spending surge is through revolutionary changes to healthcare delivery. We need policy changes that remove the 85% Medical Loss Ratio (MLR) coupled with competitive price bidding for contract awards. Cost management innovations and at risk downstream contracting with providers and vendors would also produce true cost of care savings.

MCOs who get innovative with programs that control the cost of care will survive and thrive. Those that are currently happily accepting the annual increases given for Medicaid won’t survive. Without attempting to reduce true costs, these companies are part of the skyrocketing costs of care within the entire system.

We need to make changes now. We need a sustainable program of care.

As a taxpayer, father, husband, CEO, concerned citizen, aiding in this change has become my passion.

What is the top item on your “bucket list?”

My top bucket list item would be to take a company public and ring the opening bell at the NYSE.

What do you enjoy doing most with your personal time?

Spending time with my family and watching my son’s basketball games, attending his practices are some of my most enjoyable times.

Who is your favorite historical figure and why?

My favorite historical figure is Barack Obama, who defied all odds to become President through self confidence.

What is your favorite junk food?

My favorite junk food is Salt and Vinegar Peanuts.

Of what accomplishment are you most proud?

I am proud to be an attentive partner to my wife and highly engaged father to my children.

For what one thing do you wish you could get a mulligan?

I wish I could go back and sell my Accretive stock at the high of $35.00 /share instead of the $18.00 per share that I sold.

What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

I believe that we need to inject Capitalism into the system, and create incentives for true cost reductions by implementing the three changes to Medicaid that are outlined in my book, Trillion Dollar MEDICAID Monster.

  • Remove 85% MLR
  • Make managed care contracting decisions based on price
  • Move all Medicaid recipients from Fee for Service programs to Managed Care


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