HPC on lookout for medical health insurance merger impacts

BOSTON (SHNS) – The state Well being Coverage Fee plans to observe the latest merger of Tufts Well being Plan and Harvard Pilgrim Well being Care, maintaining a tally of what the transaction means for the costs folks pay for insurance coverage, general medical spending, and the state of the well being care system.

Fee chair Stuart Altman mentioned that whereas the HPC will not be among the many businesses that was accountable for reviewing and green-lighting the merger — a listing that included the U.S. Division of Justice, the state Division of Insurance coverage, and Legal professional Normal Maura Healey’s workplace — the mixture of two main gamers within the state’s medical health insurance panorama constitutes an “vital change.”


“For the commissioners and the workers, I need to make it very clear we aren’t simply going to let this go with out persevering with to observe its actions,” he mentioned at a Wednesday meeting.

Altman mentioned the fee has the authority to evaluation how the brand new group adheres to the state’s cost-growth benchmark, and Kate Scarborough Mills, who leads the HPC’s market oversight and transparency division, mentioned the fee will monitor the deal as a part of its common duties and “centered analysis efforts”.

“Particularly, most of the potential advantages of the transaction to members and premium payers actually activate the events really integrating their operations to realize efficiencies and supply administrative simplification, however even when these efficiencies are achieved, it will likely be crucial to make sure that they really translate into financial savings for ratepayers,” Mills mentioned.


The well being plans’ merger took effect on Jan. 1. The businesses have mentioned their new group, to be primarily based in Canton, will serve 2.four million members, and forecast that $100 million in financial savings on account of “administrative synergies” will probably be immediately utilized to mitigate premium will increase and member out-of-pocket burdens.

Mills mentioned Tufts and Harvard Pilgrim are usually not proposing many short-term modifications, and that they’ve mentioned “that any system migration or integration that might influence product choices or companies will probably be undertaken solely after vital and thorough planning to keep away from any disruption to constituents.”

New state legal guidelines have tasked the Well being Coverage Fee, a state company created below a 2012 well being care value management regulation, with conducting a sequence of research, and people tasks’ timelines have been outlined throughout the assembly.


A well being care regulation Gov. Charlie Baker signed on New 12 months’s Day directs the HPC to check the usage of telehealth companies, together with prices and entry, and the influence of COVID-19 on the Massachusetts well being care system. Each of these research are to be executed in session with one other state entity, the Heart for Well being Info and Evaluation.

An interim report on COVID-19 impacts is due April 1, with a closing report by January 2022. The regulation provides the HPC one 12 months for an interim telehealth report and one other 12 months after that to provide a closing model.

That very same regulation additionally requires Well being and Human Companies Secretary Marylou Sudders, in session with the HPC, CHIA and the Division of Insurance coverage, to make suggestions by Sept. 1, 2021 on establishing out-of-network billing charges.


This 12 months’s state finances, signed into regulation on Dec. 11, provides the fee till June 15, 2021 to research and make suggestions round potential entry right into a multi-state nurse licensure compact, which thus far contains 34 states however not Massachusetts.

“I feel it’s a testomony to the work of the HPC that the Legislature retains asking the HPC to do increasingly,” commissioner Tim Foley mentioned. He requested if the company’s finances had additionally been elevated.

“It is a lot of labor, there is no such thing as a doubt about it,” HPC Govt Director David Seltz replied. “That is an formidable agenda on prime of a well being care system that’s nonetheless very a lot struggling, a workforce that has been extraordinarily taxed as you understand, and our function is growing.”


Seltz mentioned the HPC finances was “permitted on the quantity we had requested” in January 2020, a degree that doesn’t mirror calls for of the COVID-19 disaster and new mandates.

The fiscal 2021 finances allocates about $10 million for the HPC, up from roughly $9.eight million within the earlier 12 months’s finances.

“We’re going to must make this work with what now we have,” Seltz mentioned, including that the company is “effectively poised” for the brand new research due to its earlier analysis.