MMIT Payer Portrait: Point32Health
Canton, Mass.-based Point32Health was established Jan. 1, 2021, following the successful merger of Harvard Pilgrim Health Care and Tufts Health Plan, two major players in the New England health insurance market. Its name, unveiled in June 2021, alludes to the 32 points on a compass and represents a shift toward person-centered, technology-focused care delivery, according to an article in the Boston Globe. With more than 1.7 million members, Point32Health is one of the largest insurers in New England, serving members across the spectrum of insurance products. The org’s top state market is Massachusetts, where it is the second-largest insurer overall, serving the state’s managed Medicaid program and offering products through its Affordable Care Act exchanges. Notably, Point32Health is the largest Medicare Advantage insurer in Massachusetts, beating out UnitedHealthcare and Blue Cross Blue Shield of Massachusetts.
In September 2021, Point32Health selected OptumRx as its pharmacy benefits manager (PBM), with a three-year contract slated to begin Jan. 1, 2023. Harvard Pilgrim currently contracts with Optum for its pharmacy benefits, including specialty pharmacy services, while Tufts’ legacy PBM is CVS Caremark. Optum also serves as the combined org’s behavioral health vendor.
In 2021, its first year as a combined organization, Point32Health saw adjusted net income of $156 million and $9.4 billion in total revenue at year-end. The nonprofit was running at an operating loss of $11.7 million but had investment income of $175.5 million. “While we navigated financial pressures throughout the year in some of our lines of business, our strong investment portfolio has helped us weather volatility,” Chief Financial Officer Umesh Kurpad said in a March 22 press release. Kurpad pointed out that the company spent $244 million on COVID-19 related activities, including testing, treatment and vaccine administration. The company has yet to release its second-quarter 2022 financials but reported a net loss of $2.1 million in the first quarter.
Since its combination, Point32Health has focused on increasing access to virtual care and new health equity initiatives, such as its partnership with Eleanor Health, which established a value-based care model for members experiencing substance abuse and other mental health issues. The org was also one of many insurers to offer new travel benefits to members affected by the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization.
SOURCE: AIS’s Directory of Health Plans as of July 2022; MMIT Analytics as of 3Q 2022.