HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that in June, Massachusetts-based Tufts Health Plan filed an application with the Rhode Island Department of Business Regulations to offer health insurance products throughout the state. According to the latest New England Health Plan Analysis, Tufts' entry into Rhode Island is not yet finalized, as the insurer is negotiating provider agreements, including securing deals similar to what market leaders Blue Cross Blue Shield of Rhode Island and UnitedHealthcare of New England have in place.
"In Massachusetts, Tufts is competing with Blue Cross Blue Shield of Massachusetts and Harvard Pilgrim Health Care in a very crowded market," said Ric Gross, market analyst with HealthLeaders-InterStudy and author of the report. "As a result, Tufts is looking toward regional expansion to grow its business. After bouncing back from operating losses and declining enrollment several years ago, the company is in a good financial position and feels the time is right to make this move."
According to the report, Tufts is not the only local carrier to explore regional growth opportunities. Harvard Pilgrim Health Care, the number two insurer in Massachusetts, has been working to strengthen its position in Maine and New Hampshire.
Data from HealthLeaders-InterStudy's Managed Market Surveyor-Rx finds that in Rhode Island, membership for Blue Cross Blue Shield of Rhode Island totals more than 440,000 as of January 1, 2008, and membership for UnitedHealthcare is more than 244,000.
Currently, Tufts covers about 8,000 Rhode Islanders working in Massachusetts. The plan also has contracts with area hospitals and providers, though at a higher rate than the in-state plans.
"Provider negotiations are a key component of how well Tufts will be able to compete for market share in Rhode Island," stated Gross. "Tufts Health Plan is a well-known name in Rhode Island because of its success in Massachusetts. While it likely will not change market share overnight, the company is in a solid position to see incremental growth."
About Health Plan Analysis
Health Plan Analysis identifies key health plan trends, allowing healthcare businesses to create comprehensive strategic plans and sales strategies at state and local levels. Updated quarterly, Health Plan Analysis provides a detailed look at plan design and financials, as well as information about mergers, legislation and other influencers driving healthcare in a particular region.
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