{"id":87607,"date":"2025-10-20T23:01:15","date_gmt":"2025-10-20T23:01:15","guid":{"rendered":"https:\/\/www.newsbeep.com\/il\/87607\/"},"modified":"2025-10-20T23:01:15","modified_gmt":"2025-10-20T23:01:15","slug":"amid-rising-health-costs-more-layoffs-at-point32health","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/il\/87607\/","title":{"rendered":"Amid rising health costs, more layoffs at Point32Health"},"content":{"rendered":"

Through June, Point32, which insures nearly 2 million people, reported a $96 million operating loss on $4.9 billion in revenue, largely, it said, resulting from high medical and pharmaceutical spending on GLP1s<\/a>, targeted immunomodulators like Skyrizi and Dupixent, oncology drugs, and drugs for cardiac amyloidosis. <\/p>\n

That loss was narrower than what Point32Health reported a year ago for the same time period: $155 million operating loss on $4.7 billion in revenue. <\/p>\n

The reduction comes as insurers across Massachusetts are shrinking workforces, changing networks, and raising premiums. This month, the state\u2019s largest insurer, Blue Cross Blue Shield of Massachusetts, said it would offer severance packages<\/a> to workers 55 and older who have been with the company for at least 10 years. Those employees account for about 18 percent of Blue Cross\u2019s 4,200-person workforce, or approximately 750 people. <\/p>\n

While no layoffs were scheduled, Blue Cross hadn\u2019t ruled them out. <\/p>\n

Reductions are only the latest move the insurer has made to offset losses. <\/p>\n

In the merged market, which covers individuals and small businesses purchasing commercial insurance, Point32\u2019s two insurers both levied double-digit premium increases for 2026: 12.6 percent for Harvard Pilgrim Health Care (which has 90,561 members) and 11.5 percent for Tufts Health Public Plans (with 187,126 members).<\/p>\n

\"Point32HealthPoint32Health chief executive Patrick GilliganCourtesy of Point<\/p>\n

The insurer, the state\u2019s largest Medicare Advantage provider, has also changed some of its Medicare Advantage plans. For 2026, Point32Health had eliminated its zero-dollar preferred provider network plan, or PPO, which gives people greater choices of doctors, and consolidated two premium-free HMO plans into one.<\/p>\n

Financial problems are not exclusive to the insurance industry. According to the Center for Health Information and Analysis, more than half of all hospitals in the state are operating in the red. Further Medicaid changes and uncertainty with NIH funding could put further pressure on providers.<\/p>\n

But as providers are turning to insurers for higher reimbursements to offset those losses, insurers are increasingly unwilling to pass on higher premiums to their clients to accommodate them. <\/p>\n

Blue Cross Blue Shield of Massachusetts chief executive Sarah Iselin said<\/a> she put providers on notice, saying the insurer would be holding provider increases this coming year to the state\u2019s cost growth benchmark, or 3.6 percent. <\/p>\n

Gilligan, too, said in an interview with the Globe that insurers couldn\u2019t just accommodate higher provider rates by levying sizable premium increases to consumers. In the past, insurers would typically hike premiums on employers, who often then pass them on to their workforces in the form of higher deductibles. That\u2019s not sustainable, he said.<\/p>\n

\u201cEmployers are saying they can\u2019t do that anymore,\u201d Gilligan said. \u201cThe providers need to understand the terms of why we can\u2019t keep doing this anymore. I want to have proactive discussions of how can we do it differently.\u201d<\/p>\n

The challenges are substantial for Gilligan, who stepped into the role of CEO in June after holding roles at management consulting firm CWH Advisors, Blue Cross Blue Shield of Massachusetts, Indigo Insurance Services, Zaffre Investments, and CVS Health. <\/p>\n

But Gilligan has a plan, starting with changing Point32Health\u2019s financial outcome over the next two years. Though it has started with looking internally at their own costs, Gilligan said the solutions needed to be broader. <\/p>\n

\u201cThe one thing we should all agree on is health care is too expensive,\u201d Gilligan said. \u201cI\u2019ve worked on both sides, been on the providers and health plan side, and have worked to be collaborative. But with the tension and focus of COVID and post-COVID, the sides have gone to their corners. Providers are saying it\u2019s the health plans\u2019 fault, and health plans saying it\u2019s the providers\u2019 fault. We have to figure out better ways to address this.\u201d<\/p>\n

Jessica Bartlett can be reached at jessica.bartlett@globe.com<\/a>. Follow her @ByJessBartlett<\/a>.<\/p>\n