CANTON — Cain A. Hayes, the new chief executive of Point32Health, describes himself as the kind of person who gets energy from being around others. But given the complicated state of the world during the COVID pandemic, Hayes began his job when nearly all of his employees were working from home.
In this unusual environment, Hayes, a seasoned executive and newcomer to Massachusetts, is responsible for bringing together two of the state’s best-known health insurers — Tufts Health Plan and Harvard Pilgrim Health Care — and leading the company created earlier this year through their merger.
The company, Point32Health, didn’t exist when employees were last in the office.
“I like to think about us as a $9 billion startup,” Hayes said in an interview at Point32Health’s corporate office in Canton. “We’re actually building a new culture because it’s a new company.”
Hayes is now also among a relatively small group of CEOs of major companies in Massachusetts who are Black, a responsibility he said he doesn’t take lightly, as the company seeks to expand its work in health equity.
“I’m very proud to be Black, and at the same time recognizing that I need to be an excellent CEO first,” he said.
Hayes joined the company in July, succeeding Tom Croswell, who retired. Hayes is new to the Massachusetts health care market and has no history with either Tufts or Harvard Pilgrim, which makes him unlikely to play favorites.
“A merger of equals is something that doesn’t happen very often, so I saw this as a unique opportunity,” he said.
Point32Health — named for the 32 points on a compass and the company’s stated goal of helping people navigate health care — is the second-biggest insurer in the state after Blue Cross Blue Shield of Massachusetts. It holds a distinction as the only big health insurer serving all segments of the market: Its plans cover people who have private insurance through employers, those who buy coverage on the state’s Health Connector, and those covered by the government programs Medicare and Medicaid.
The company has 2.3 million members across Massachusetts, New Hampshire, Maine, Connecticut, and Rhode Island.
Starting a new job during the pandemic has forced Hayes to be deliberate about meeting people inside and outside the company and learning about the state’s health care landscape.
He held virtual coffee meetings with more than 100 employees during his first 100 days. He e-mails employees weekly with updates and holds occasional town halls. Point32Health’s workforce of 4,300 is expected to start returning to the office in January, though plans could change again given the unpredictable nature of the pandemic and the latest variant of COVID.
Hayes has diversified the leadership at Point32Health by hiring three people of color into senior leadership roles and said the company will expand initiatives that incorporate health equity into payment contracts with health care providers.
For example, the insurer is developing programs to incentivize better maternity care for people of color, who data have shown experience more complications and worse outcomes during pregnancy than white women.
Point32Health is also working to expand the data it collects on members, including race, ethnicity, language, and information about their access to food, housing, and transportation, which are known as social determinants of health.
And the company is reviewing medical policies to remove unconscious bias based on race, age, sexual orientation, and other factors, executives said.
“Every organization needs to have health equity at the center of everything they do: the practices, the policies, the decisions,” Hayes said.
Among his top priorities in these early months on the job, Hayes said, is building a culture for Point32Health that is founded on collaboration, accountability, and transparency.
Tufts and Harvard Pilgrim share many similarities as nonprofit health plans based in Massachusetts. But Harvard Pilgrim has focused almost entirely on private health coverage offered through employers, while Tufts has developed a reputation for serving seniors on Medicare.
Tufts and Harvard Pilgrim also differed in how quickly they made decisions and how much risk they were willing to take in launching new programs, Hayes said. “The cultural differences are ones that you would expect and ones that we can solve for,” he said.
Point32Health has cut about 125 jobs since the merger was finalized in January, and more cuts are on the way. Some people will be able to transition to different roles and avoid layoffs, Hayes said.
Consumers and employers have seen few big changes since the merger, though one sign of consolidation came this fall when Point32Health said it would stop offering Medicare Advantage coverage through Harvard Pilgrim in Massachusetts and urged the 9,600 members of that plan to move to a Tufts Medicare Advantage plan instead. Company officials said the Tufts plan includes a broad network of doctors.
The company is also pulling Harvard Pilgrim out of Medicare Advantage in Maine, where it has about 1,600 members.
For now, Hayes said, Point32Health isn’t planning to consolidate or stop offering any other plans.
Amy Rosenthal, executive director of Health Care For All, a consumer advocacy group that initially raised concerns about the Tufts-Harvard Pilgrim merger, said she met with Hayes soon after he arrived and is eager to work with him.
“His commitment to ‘total health’ creates opportunities to focus on a number of issues that are important to Health Care For All, including behavioral health, social determinants of health, and the affordability and accessibility of care,” she said in a statement.
Hayes, 52, arrived at Point32Health after about three years leading Gateway Health, a managed care company in Pittsburgh whose members are covered by Medicare and Medicaid. He previously held executive positions at Blue Cross and Blue Shield of Minnesota and Aetna.
Hayes grew up in Ferguson, Mo., and was raised by a single mother who taught him to value education. He lived in the neighborhood where Michael Brown, an unarmed Black teenager, was killed by a white police officer in 2014, sparking national protests. “It hit me in a very personal way,” he said of Brown’s death.
He calls his grandfather, a World War II veteran who served in Normandy, his hero, and said he admires and tries to emulate the leadership style and optimism of the late Colin Powell.
Hayes worked in financial services before shifting to health care in 2010, inspired partly by the Affordable Care Act and the opportunity it represented for expanding health coverage to more Americans.
When he moved to Massachusetts this year, he wasted no time in seeking out other executives and power brokers. He scheduled meetings with leaders of all the big hospital systems — with whom his company negotiates prices for health care services. He went to a New England Patriots game and chatted with team owner Robert Kraft. He had a detailed health care discussion with Governor Charlie Baker, a former CEO of Harvard Pilgrim.
“I’ve probably had 15 one-on-one conversations with governors in different states. I’ve never had a conversation like I had with Governor Baker,” Hayes said. He said Baker shared helpful leadership advice, including the importance of focusing on culture.
Baker didn’t divulge anything from the conversation but said in a statement, “I welcome Cain to the Massachusetts health care community, and wish him the best of luck in his new position, which comes at an exciting time for the newly formed Point32Health.”
Andrew Dreyfus, the chief executive of Blue Cross Blue Shield of Massachusetts, Point32Health’s biggest competitor, said Hayes is a good fit for the state’s health care market.
“He understands the critical role that not-for-profit health plans play in this market, unlike most other markets in the country in which publicly traded plans dominate,” Dreyfus said. “I think it could be a real advantage to come from outside the market and bring fresh thinking to two strong but different organizations.”