Health care is at a crossroads. Costs continue to rise, access remains a challenge for many, and individuals, families, and employers are feeling the strain. 

Drawing on decades of health care leadership, Patrick Gilligan, president and CEO of Point32Health — the parent company of Harvard Pilgrim Health Care and Tufts Health Plan —sees a defining challenge: make care more affordable, accessible, and easier to navigate.

We spoke with Gilligan about what’s shaping health care today and what it will take to create a more affordable and sustainable future:

Q: What’s one lesson you’ve learned throughout your career that continues to shape the way you approach health care today? 

PG: One lesson that has stayed with me throughout my career, including as president and CEO of Point32Health, the parent company of Harvard Pilgrim Health Care and Tufts Health Plan, is the importance of understanding different perspectives across the health care system. While working closely with providers, employers, and other stakeholders, I understand that each experience the system differently. When you appreciate how those perspectives intersect, along with the incentives that drive them, you gain a much deeper understanding of both the challenges we each face and the opportunities we have to improve affordability, access, and the overall member and patient experience.

I’ve also learned that meaningful progress never happens in a silo. The health care system is deeply interconnected, and lasting and meaningful solutions require collaboration among providers, employers, policymakers, health plans, and communities. The challenges we’re facing today are too complex for any one organization to solve alone.

Q: What are the biggest barriers people face when it comes to health care today?

PG: Affordability continues to be the biggest barrier. Too many families must choose between paying for their health care, putting food on the table, or covering their rent, and they simply can’t afford all three. That is unacceptable.

Employers face the same pressures: Absorb rising premiums or shift more costs to employees. Neither is sustainable. Health plans, providers, pharmaceutical companies, and policymakers must work together to lower costs.

Access compounds the problem. Provider shortages, long waits, caregiving responsibilities, and transportation barriers can make it difficult to access care when needed. Delayed care often leads to poorer health outcomes and added strain for individuals and families.

Health care shouldn’t operate this way. It should be accessible to everyone and paying for it shouldn’t keep people from having food on the table or a roof over their heads. Frankly, that’s one of the primary reasons I took this position: to help drive meaningful, lasting change and address the many challenges facing the health care industry for the benefit of our members and employer customers.

Q: What’s at the root of today’s health care affordability challenge? 

PG: Medical and pharmaceutical costs have surged since the pandemic, straining families and employers. As an organization, our colleagues have worked tirelessly to help address rising health care costs. We are making meaningful progress in slowing premium growth, as reflected in our 2027 rate filings, which include the lowest approved premium increases in the region. While there is still more work to do, the entire organization is focused on delivering greater value to our members and customers.

Waste and inefficiency also drive costs — from avoidable care and poor coordination to duplicative processes and administrative burden. A core problem is how care is paid: fee-for-service rewards more visits, tests, etc., and not better outcomes.

We need to rethink payment arrangements in close partnership with providers, drug manufacturers and prescription benefit managers so incentives are aligned around quality, outcomes, and prevention. We also need to redesign where care is delivered — moving services to the most appropriate, convenient, and cost-effective settings by paying for value rather than paying for volume and inflated prices. This will reduce waste, improve health, and control costs while giving providers more flexibility and support to deliver better care.

Q: What will it take for the health care industry to make meaningful progress?

PG: Health care needs to be simpler to navigate, both for members and providers. Complexity wastes time, raises costs, and frustrates everyone.

Technology can help address some of health care’s biggest frustrations, particularly the complexity that creates friction for both providers and members. For providers, we’re focused on making it easier to do business with us by expanding digital tools and improving how we exchange information. We’re building on that work with our next-generation provider portal, designed to simplify routine interactions and give providers more time to focus on patient care.

For members, technology should remove barriers, not create them. People should be able to more easily find care, understand their benefits, access information, and get answers when they need them. That’s why we’re also investing in modernizing the member experience, including a comprehensive overhaul of our member portal.

But technology alone isn’t enough. We also need stronger collaboration across the health care system and continued efforts to align incentives around quality, outcomes, and value. Health plans, providers, policymakers, and community partners must turn collaboration into practical solutions that lower costs, reduce complexity, expand access, and create better experiences for the people we serve.

Q: What does it mean to create a health care experience that puts patients first?

PG: Putting patients first means putting them in the driver’s seat for their own health. Too often, especially during a serious illness or unexpected health event, they’re swept into a complex system that’s difficult to navigate. It shouldn’t be that way.

People should have the tools and information to manage routine needs on their own, while also knowing meaningful human support is there when they need it. Health care is deeply personal, and when someone is facing a complex diagnosis, a difficult decision, or an important moment in their care, empathy and expertise matter. The best experiences give people greater control while making sure they never feel like they have to figure everything out on their own. At Point32Health, our colleagues put our members first by focusing on one question when making decisions: How does this improve our members’ health and experience while providing value? That mindset should drive decisions across the health care system.

Q: What role can regional, nonprofit health plans play in today’s health care landscape?

PG: Without shareholders or quarterly earnings to consider, regional, nonprofit health plans that are truly independent, like Point32Health, keep members and communities at the center of their decision-making. Independence creates flexibility to act in the best interests of the people we serve, living up to our purpose. 

That focus matters because roughly 90 cents of every premium dollar pays for our members’ care, while the remainder supports operations, technology, and the infrastructure needed to serve them.

Local roots also matter. As the only independent health plan in Massachusetts that serves all segments of our population, our dedicated colleagues are our members’ neighbors. They live and work in the communities we serve, bringing a firsthand understanding and deep commitment to local needs. Those connections extend across the health care system as well. Because we’re a regional plan, we’ve built strong relationships with providers, employers, brokers, and community organizations throughout the states we serve. That level of connectivity helps us identify challenges quickly and work collaboratively on solutions that improve affordability, access, and quality. Point32Health companies Harvard Pilgrim Health Care and Tufts Health Plan have earned trust across New England over multiple generations. That trust carries a responsibility to support our members every day, especially when they need us the most.  

Q: What opportunities are ahead for the health care industry?

PG: The health care industry has both an opportunity and an obligation to create greater value for members and employers. That means improving affordability, aligning incentives around outcomes, and making care easier to navigate.

The challenge in front of us is significant, but so is the opportunity. The decisions we make today will shape how people experience health care in the future, and we have a responsibility and an obligation to build a system that is more sustainable for generations to come. 

Point32Health, the parent company of Harvard Pilgrim Health Care and Tufts Health Plan, is a leading nonprofit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, our purpose is to guide and empower healthier lives.