TOM CROSWELL, the insurance executive who orchestrated the merger of Harvard Pilgrim Health Care and Tufts Health Plan, says combining the second and third largest health insurance companies in the state will pay dividends for consumers, but he’s not so sure about the benefits of similar consolidations elsewhere in health care.
Croswell estimates the combined nonprofit company, which hasn’t been christened with a new name yet, will eliminate duplicative infrastructure and realize $100 million in premium savings for consumers over the next five years.
“We didn’t combine these two companies to produce a return for shareholders. We don’t have shareholders,” he said on The Codcast with Paul Hattis, retired from Tufts University Medical School, and John McDonough, who teaches at the T.H. Chan School of Public Health at Harvard University. “We did it to further the achievement of our mission, which simply stated is to improve the health and wellness of the communities we serve.”
Croswell is less certain about the benefits of other consolidations in the health care space – the proposed acquisition of Atrius, a 715-physician group based in Newton, by Optum, the subsidiary of the for-profit United Health Care, which also acquired Reliant Medical Group in 2017, and the consummated merger of Beth Israel Deaconess Medical Center and Lahey Health.
On Optum’s pursuit of Atrius, Croswell said the benefit of that consolidation is unclear. “At this point, I think it’s difficult to tell whether this acquisition, if it goes forward, will be a good thing. I think we need to understand it better,” he said.
Regarding Beth Israel Lahey’s ability to generate competition with Mass General Brigham that would benefit consumers, Croswell said the verdict is also still out. “The question of whether the combination has lowered costs versus what they would have been absent the combination, frankly, is a tough question to answer definitely, in part because the combination is so recent and, again, we’re trying to measure against something that would have been absent the combination.”
Croswell said the BI Lahey-Mass General Brigham faceoff hasn’t materialized yet. “I don’t think BI Lahey has yet hit its stride,” he said. “I don’t think the results are in on that yet.”
Croswell, 71, has spent 50 years working in the health insurance field. He came to Tufts Health Plan in 2007 and became CEO five years ago. He is currently the CEO of the new Harvard Pilgrim-Tufts company, but plans to step down and retire this summer. He is also the chair of the Massachusetts Association of Health Plans.
Over the years, Croswell has seen a lot of change in health care. He credits the creation of the state Health Policy Commission for helping to rein in health care costs in Massachusetts, but he said the agency is hampered by its limited authority in regard to prescription drugs. “Everyone is held to a certain level of accountability with one glaring omission – that’s drug manufacturers,” he said, adding that addressing drug costs in a comprehensive fashion would require federal intervention in the market.
Croswell also thinks the Legislature and the governor did a good job last session crafting legislation on telehealth, which allows health providers to be reimbursed at the same rate for telehealth visits as they are for in-person visits, although payment parity is not permanent for all types of visits. “The Legislature and the governor did largely get it right. We’re very supportive of telehealth, particularly for behavioral health,” he said.
Before the pandemic, Croswell said less than 2 percent of the company’s claims were for telehealth visits. Last April, at the height of the pandemic, the percentage rose to 60 percent before dropping down to 20 percent today. He said telehealth has accounted for a steady 80 percent of behavioral health visits over the last 11 months.
“As far as payment parity is concerned, I do think at some point we may want to revisit those policies to ensure consumers are getting the best care and value from telehealth,” he said. “We do think this delivery method should be less costly than in-person office visits.”