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What’s Next for Harvard Pilgrim Health Care and Tufts Health Plan Merger? Vice President Patrick Cahill Shares Update
Oct 20

This year’s member-owner meeting included a presentation from Point32Health’s Vice President of the Massachusetts Market, Patrick Cahill, on the Harvard Pilgrim Health Care and Tufts Health Plan merger. The two plan administrators cover the majority of edHEALTH’s member schools. The name Point32Health refers to the 32 points on a compass. “Our combined organization’s mission is to guide members to better health,” said Patrick Cahill. He likened Point32Health to a holding company with the Harvard Pilgrim and Tufts Health Plan brands continuing for the foreseeable future.

Cain Hayes is Point32Health’s new Chief Executive Officer, succeeding Tom Croswell, who retired in July. Cain Hayes leads the company’s executive team; ensures a strong culture of quality, innovation, and customer service; and defines strategic vision and direction. Previously he held leadership positions at Gateway Health, Blue Cross and Blue Shield of Minnesota, and Aetna. edHEALTH’s account team will stay the same. “All the account team representatives and directors who member schools have worked with at Tufts and Harvard will remain at the combined organization,” said Patrick.

The organization is leveraging its combined purchasing power to negotiate better provider prices for employers and their employees. It’s also taking a systemic approach to improve healthcare equity for the communities it serves and its members. “We’re looking for quick wins that will best serve our clients and members,” said Patrick. The company is identifying which programs, systems, and processes rise to the top. For January 1, 2022, the plan will:

  • Integrate health condition management programs
  • Roll out the Harvard Pilgrim Living Well wellness program to Tufts Health Plan members
  • Extend the Harvard Pilgrim MyHealthMath decision support system to edHEALTH schools at a preferred price. This tool helps employees identify the financially optimal health plan.

In 2023 and early 2024, the organization will:

  • Integrate its claims platform
  • Roll out a single national provider network
  • Insource behavioral health benefits

“By providing an integrated behavioral health program, we seek to improve access to the mental health care patients needs and reduce comorbidities with medical conditions,” said Patrick.

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