PATRICK GILLIGAN HAS spent a year trying to fix Point32Health’s finances. But after “serious financial challenges” and hundreds of layoffs, he’s not sure that’s enough. The president and CEO of the parent company of Harvard Pilgrim Health Care and Tufts Health Plan argues that the Massachusetts health care system is built around the wrong incentives, and that no single insurer can fix that on its own.

Gilligan joined John McDonough of the Harvard T.H. Chan School of Public Health and Paul Hattis of the Lown Institute on the monthly Health or Consequences episode of The Codcast, one day before the one-year mark of his taking on the post.

“I can’t tell you how many years we’ve been saying that health care cost increases are unsustainable,” he said. “But when I say it’s unsustainable, I’m really thinking it’s unsustainable.”

Point32 posted a net income of $248 million in the first quarter of 2026, after a $141 million net loss in 2025 and more than 450 layoffs across three rounds since last spring. Gilligan attributed the uptick partly to the sale of Integra Partners, a Point32 subsidiary, calling it a one-time item.

On the operating side he said, the improvement reflects cost discipline, new care management programs, and the decision to stop covering GLP-1 drugs solely for weight loss as of January 1. He describes 2026 as a “bridge year” and says a full year of profitability is not guaranteed.

Gilligan kept returning to the structural problems he says precede Point32’s troubles. On the Senate’s primary care bill, which would open the primary care spending target at 9 percent of overall commercial health care spending and step it up to 15 percent after three years, he said higher reimbursement alone won’t solve the access crisis.

“Primary care is in a crisis right now because of access,” he said, but also because there is more reliance on less-skilled workers. Many primary care providers “are more often referring and moving patients around,” Galligan said, rather than trying to address the issue without specialists.

“Maybe they could be caring for some of their diabetics and not referring them to a specialist,” he said. “Those types of things would actually reduce costs.”

He called the CVS MinuteClinic–Mass General Brigham affiliation, which the Health Policy Commission projected would add around $40 million in annual spending by year three, an experiment in retail primary care. He referred approvingly to Harvard Kennedy School professor Leemore Dafny’s argument that provider consolidation is a primary engine of rising costs, saying the problem is more acute on the provider side than on the insurance side, even as he runs a company formed by a merger of two health plans.

Gilligan said fee-for-service payment has been inflating costs for decades, and that technology like AI tools will help to reorient care around patients rather than clinicians. The technology shift, he said, will give members real-time information to choose lower-cost settings for imaging, make better decisions about generic versus brand-name drugs, and stay out of the hospital in the first place. Point32’s nonprofit structure, he said, positions it to lead on that shift in ways a shareholder-driven company could not.

“What has to happen in health care is that we need to reorient the focus and design care around the member and the patient, not around the clinician,” he said. “I think technology will help get us there over the next decade.”

On the episode, Hattis, McDonough, and Gilligan discuss Point32Health’s financial turnaround and the GLP-1 coverage decision (1:40), small employer premiums and consumer cost-sharing (10:00), and the long-term outlook for Massachusetts health care (36:20).