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Tufts Health Plan expands telehealth amid Harvard Pilgrim merger

The force driving change is data and consumer demand, expert says.

Susan Morse, Managing Editor

Tufts Health Plan, which is going through the regulatory process to merge with Harvard Pilgrim Health Plan, has announced an expansion to its telehealth services.

At no cost and through a Teladoc app, commercial members can access U.S.-based, board-certified providers for general medical needs and diagnoses. Tufts Health Plan launched telehealth in 2018 as one of several digital tools for commercial members.

WHY THIS MATTERS

Telehealth capitalizes on the focus toward consumer convenience while saving money for employers and insurers.

Cost efficiencies are also expected to be realized when the merger between Tufts and Harvard Pilgrim Health Care is completed. 

The two New England non-profit insurers announced their intention to merge in August 2019. They are continuing to go through the regulatory process and hope to close the deal by late summer or early fall, according to a company spokesman.

The merger gives both insurers an integrated strength in an increasingly consolidated market, in an area dominated by the large Partners HealthCare system, which includes Massachusetts General and Brigham and Women's hospitals.

In 2018, Harvard Pilgrim was in talks with Partners for what was called a potential collaboration, in a deal that did not go through.

"It's been a race to the top, a merging frenzy," said Dr. Emad Rizk, CEO of Cotiviti, an analytics company that works with more than 180 payers in handling member data. "We're seeing another seismic shift in healthcare. The force driving this change is data. Consumer demand will drive the leveraging of data in a truly disruptive way which will result in the sharing of data across providers and payers."

Payer mergers help companies expand not only their total membership, but different types of members and all of the data that entails, Rizk said.

In the case of Tufts-Harvard Pilgrim, Tufts brings Medicaid business to the merger, while Harvard Pilgrim and its focus on private insurance plans, brings analytics company Benevera Health.

Benevera was formed in 2015 by Harvard Pilgrim Health Care and New Hampshire hospitals Dartmouth-Hitchcock, Elliot Health System and Frisbie Memorial. It has since expanded to include St. Joseph Hospital, which is also in New Hampshire.

THE LARGER TREND

In making the merger announcement, Harvard Pilgrim said a combined organization would improve affordability through scale and administrative cost efficiencies.

"I think that is an outcome that is always there," Rizk said. "Cost of care has efficiencies and inefficiencies, and also has gaps. When mergers come together to leverage data and solutions, you can argue they can begin to close gaps in care. They're able overall to reduce the cost curve."

Rizk sees the challenge for companies as being the ability to merge their vast amounts of data.

"One of the amazing things about payers looking to merge, is to look at the systems and different applications on how to get and leverage data and store data," Rizk said. "The other thing is, when you go through a merger is the engine behind how data is analyzed: rules, logic and algorithms, the brain behind it. Are you defining a diabetic the same way?"

ON THE RECORD

"For members seeking more convenient and immediate access to medical care, we are removing all of the barriers to assure our members seek and receive care when they need it," said Jim Gallagher, vice president, marketing and product strategy for commercial products at Tufts Health Plan. "This market-leading benefit is part of our overall goal to create a world class experience for our members with innovative digital tools and services."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com