Tufts Health Plan and Harvard Pilgrim Announce Merger

Tufts Health Plan and Harvard Pilgrim Health Care will be merging, the two companies have announced.

The new company, whose name is still pending, will serve around 2.4 million New Englanders in Massachusetts, Maine, Connecticut, New Hampshire, and Rhode Island.

“Building upon our collective synergies and strengths – which includes being among the top-rated health plans in the country for quality – will unlock value that can be immediately reinvested in our members and the communities we have the privilege of serving,” said Greg Tranter, chair of the board for Tufts Health Plan. “I am excited about the future.”

Through this merger, the combined company will become one of the largest nonprofit health services organizations in New England. The company will offer plans to consumers across the spectrum of socioeconomic and demographic backgrounds, from employer-sponsored insurance and quality health plans to Medicare and Medicaid and dually eligible plans.

The board will be a balance of Tufts and Harvard Pilgrim board members with Joyce Murphy, current chair of Harvard Pilgrim Health Care, as the board’s chair and Tom Croswell, president and CEO of Tufts Health Plan, as chief executive officer of the organization. The new company’s president will be Michael Carson, the current president and CEO of Harvard Pilgrim Health Care.

“Our communities and consumers today face four major hurdles in health care:  affordability, access, quality of health and a fragmented health care experience across various stakeholders and health systems. Through our shared vision, we believe we can tackle these issues and bring more value to the communities we serve,” said Croswell.

The nonprofits aim to maintain their emphasis on philanthropy. The companies plan to deliver affordable care through their scale and administrative cost efficiency. They also expect to see greater patient care access through their enlarged footprint and their diverse new set of offerings across all socioeconomic backgrounds and ages.

By collaborating with providers and increasing innovation with their tools and capabilities, Tufts and Harvard Pilgrim aim to improve population health quality and outcomes and to elevate the patient experience.

Harvard Pilgrim was previously in merger negotiations with Partners HealthCare back in 2018. Harvard Pilgrim’s goal at the time was to achieve strong patient outcomes, address high healthcare costs, and improve patient experiences. The conversations ended in November 2018 when Partners HealthCare stated that the merger would likely not survive the regulatory process.

Tufts Health Plan’s reputation precedes it.

For the past four years, Tufts Health Plan saw success in its five-star rated Medicare Advantage plans. The payer earned its stars through effective chronic disease care, preventive care, and member engagement with drug plans. The only area in which its Medicare Advantage plan fell short was in prescription drug plan customer service and drug pricing.

Tufts Health Plan also serves as one of the newest options for Rhode Island’s Medicaid coverage.

"We are ecstatic that Rhode Islanders receiving Medicaid will now have another great option for administering their health care benefits," stated Patrick Tigue, Rhode Island's Medicaid director when the partnership was announced. “Tufts Health Plan has an outstanding reputation and we are happy they will partner with us and expand in our state.”

The nonprofit is notable for its consumer wellness benefits including more rare offerings such as biometric screenings and fairly common like fitness club membership rebates. It also offers free medication therapy management to Medicare beneficiaries.

“Through the combination of two strong organizations with a commitment to non-profit health care in New England, we will be able to provide even greater value to consumers, as well as improve access to care throughout the region,” said Murphy.

The merger will be subject to review at the local and federal levels. Harvard Pilgrim Health Care and Tufts Health plan will continue to operate autonomously as the regulatory process moves forward.