In last month’s issue of the provider newsletter, we let you know about the progress we have made in combining Harvard Pilgrim Health Care and Tufts Health Plan under the parent organization, Point32Helath.
We invited you to view our newly developed, in-depth provider FAQ that provides information on what is coming in 2023 where you can learn about our more unified product portfolio, behavioral health model, new pharmacy benefit manger, our aligned approach for Medical Benefit Drugs utilization management and more. If you haven’t read the FAQ yet, we encourage you to do so today.
We’ll also be hosting provider engagement events that will help you and your staff stay apprised of the latest news and updates.
We encourage you and your office staff to sign up for one of the following sessions. To register, simply click the session of your choice:
- Wednesday, Nov. 16 from noon–1:30 p.m. ET
- Tuesday, Nov. 29 from 2–3:30 p.m. ET
- Wednesday, Dec. 7 from 8:30–10 a.m. ET
- Wednesday, Dec. 14 from noon–1:30 p.m. ET
- Tuesday, Dec. 20 from 2-3:30 p.m. ET
The sessions will cover key changes for 2023 noted below (product changes and continuity of care, pharmacy benefit manager, medical benefit drug utilization management, behavioral health, and more).
We’ll continue to offer sessions in early 2023 — and will be offering dedicated behavioral health webinars in 2023 as well — so watch for more information in upcoming issues of the provider newsletter.
For more, please visit our Provider Training and Events webpage.
Integration changes in January
As we noted in last month’s newsletter, our combined organization has made great strides in unifying processes and products. We are committed to giving you the information you need to work efficiently with us and invite you to learn more on the following key updates via our What’s Ahead at Point32Health FAQ:
- More unified product portfolio — Beginning on Jan. 1, 2023, Tufts Health Plan’s employer group clients and members of individual and small group products (including those serviced by our intermediary partners) in Massachusetts will begin transitioning to the Harvard Pilgrim Health Care product portfolio, as the Commercial Markets business moves toward a more unified product portfolio. These transitions will occur on the plan renewal date.
- Efforts to ensure a smooth transition — Learn more about the efforts we are undertaking to ensure that you and your patients experience a smooth transition, including continuity of care, plans to migrate open referrals and prior authorizations, and training and education sessions.
- Behavioral Health — Read about our plans to offer an insourced behavioral health program for both Harvard Pilgrim Health Care and Tufts Health Plan. While Tufts Health Plan currently operates using an insourced behavioral health model, this is a change for Harvard Pilgrim Health Care, which currently utilizes a carve-out model managed by Optum/United Behavioral Health. Harvard Pilgrim Health Care will utilize an insourced behavioral health program effective July 1, 2023.
- Medical Drug Program — Learn about our aligned approach for Medical Benefit Drug utilization management. Point32Health has developed medical necessity guidelines for medical benefit drugs and will conduct utilization review, effective Jan. 1, 2023. Currently, CVS Health-Novologix conducts utilization management for medical drugs for Harvard Pilgrim Health Care members; however, as of Jan. 1, 2023, CVS Health-Novologix will no longer accept medical drug authorization requests for these members.
- Pharmacy Benefit Manager — Find answers to your questions about our pharmacy benefit manager for 2023, OptumRx, including key changes for each legacy organization, services provided by OptumRx, information on brand new drug formularies for 2023, guidance on requesting prior authorization, and support for members migrating from a Tufts Health Plan Commercial plan to a Harvard Pilgrim Commercial plan.
Director, Provider Relations & Communications
Senior Manager, Provider Communications