CAIN HAYES, the president and CEO of Point32Health, says the five-year integration of the Harvard Pilgrim and Tufts health insurers is moving forward well ahead of schedule, but integration doesn’t mean the two brands will disappear.
“We have no intention of consolidating those brands into one brand,” he said on The Codcast with John McDonough of the T.H. Chan School of Public Health and Paul Hattis, a fellow at the Lown Institute.
Hayes said Harvard Pilgrim will focus on commercial business and Tufts will prioritize government work, primarily Medicaid and Medicare. He said the two health insurers, which merged at the start of 2021, are blending many aspects of their operations – they now have one headquarters in Canton and utilize one pharmacy benefit manager.
The combined company has 2.2 million members. “That gives us the scale to compete with not only our regional competitors [Blue Cross Blue Shield of Massachusetts is the largest player] but in many cases our national competitors as well in this market. So, a ways to go, but the early signs are sort of the value of the combination is really bearing fruit from a competitive standpoint,” he said.
Two other priorities of Hayes are keeping costs under control and addressing health inequities.
Telehealth is one area where Point32Health has staked out a different approach than Blue Cross Blue Shield. While health insurers must reimburse behavioral health care providers at the same rate for in-person and remote visits, they are free to charge different rates for other types of care.
Blue Cross is continuing cost parity for in-person and remote visits, but Point32Health is returning to its pre-COVID policy of reimbursing for telehealth visits at 80 percent of the rate for in-person visits. Hayes said telehealth visits have a lower cost structure and providers should be paid at a level commensurate with that structure, with the savings passed on to customers in the form of lower premiums.
“We believe that affordability of care continues to be a major issue,” he said.
Hayes also disagreed with the Massachusetts Health and Hospital Association, which last month said the state’s health care cost growth benchmark is no longer relevant and needs to be updated to reflect current realities.
“We believe that the benchmark is still important because it recognizes that joint commitment to lower overall costs,” Hayes said.
“The health care in this region is certainly world class, that’s a good thing. It’s also extremely expensive,” Hayes said. “We have to do all that we can to bring down those costs. We don’t think we should give up on that aspiration to reduce the cost of care.”
Hayes said addressing health inequities is a top priority for him and Point32Health. He urged the Healey administration to focus its efforts on addressing social determinants of health such as construction of affordable housing, removal of language barriers, and access to quality food and transportation.
He also trumpeted the value of the nonprofit health sector. “I do believe that not-for-profit health plans make a difference by putting community and the members first,” he said. “We think those things matter, and we think Massachusetts has been well-served by being one of the few markets that is still dominated by not-for-profit health plans.”
