Cain Hayes vows to retain Harvard Pilgrim, Tufts brands

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.”



Abortion pill explainer: Jennifer Smith brings the abortion pill litigation into focus both at the national and local level and explains the legal and social implications. Read more.

Referendum on Brayton Point: Somerset votes for a new member of the Select Board today, a race that Bruce Mohl writes could have ramifications for the state’s offshore wind industry. Read more.


Transfer fee sought: Brooke Mohr of the Nantucket Select Board and Dan O’Connell, the former state secretary of housing and economic development, seek a transfer fee on high-end real estate transactions to address the housing crisis on the Cape and Islands. Read more.

Housing = health: Jarone Lee, Aditya Narayan, Angie Liou, and Raymond Liu support Boston’s push for more funding for affordable housing, saying investing in housing equity is an investment  in better health. Read more.




Housing and language access were the top priorities for the Massachusetts Immigration and Refugee Advocacy Coalition as Immigrants’ Day returned to the State House for the first in-person gathering since 2019. (New Bedford Standard-Times)

House leaders will propose making pandemic-era eviction protection permanent by folding them into the chamber’s budget proposal, which will be unveiled on Wednesday. (Boston Globe

Lawmakers and architects are pushing legislation to change the state building code to allow gender neutral bathrooms in new construction or major renovations. (Daily Hampshire Gazette)


Care providers are divided over the end of mask mandates in healthcare facilities triggered by the state and federal government concluding the COVID-19 public health emergency on May 11. (Worcester Telegram)


Northampton paid $80,000 to Lori Vaillancourt, the former principal of Northampton High School, as part of a separation agreement. She was initially placed on leave last year after she referred to a group of students disagreeing with a curriculum change as “asshats.” (MassLive)


Twelve local artists competed in Lynn’s first-ever Art Battle, where the artists have only 20 minutes to do paintings in a series of rounds whittling the field to one winner. (Daily Item)


The MBTA lags behind peer transit agencies elsewhere in the country in hiring new bus drivers to restore service to pre-pandemic levels – and they all stand out from the T by allowing new drivers to begin as full-time employees; the T ramps up new drivers’ hours to full time over three to six months. (Boston Globe


Boston police Captain John Danilecki, who has been the subject of multiple misconduct allegations, is the focus of a complaint that has dragged on for two years without resolution despite it involving a case where investigators say he violated use of force guidelines and lied. (Boston Globe

Kevin Bennett, who was out on probation in connection with kidnapping and rape charges, is facing the prospect of returning to jail for 25 years after prosecutors allege he gave an address in Lawrence to probation officials but was actually living in Saugus. (Salem News)