Nonprofit health plan Point32Health is taking bold steps to transform behavioral health care through integrated care, value-based contracting, and innovative autism care programs. By coordinating mental and physical health services, forming strategic partnerships, and developing payment models that reward outcomes, the health plan is redefining how care is delivered and how results are measured.
Jill Borrelli, vice president of behavioral health at Point32Health, explained, “We believe strongly that by treating the whole person, you’re going to have better outcomes. And people are going to have a better quality of life, which is ultimately what the goal is.”
Formation of Point32Health and the Path to Integration
Point32Health was established in 2021 through the merger of Tufts Health Plan and Harvard Pilgrim Health Care. The organization now serves approximately 2.2 million members across New England, offering Medicaid, Medicare, and commercial plans.
Prior to the merger, behavioral health management was handled differently by the two organizations. Tufts Health Plan historically managed behavioral health in-house, maintaining control over clinical programs, care management, and member engagement. Harvard Pilgrim, on the other hand, outsourced behavioral health services to Optum.
This divergence created challenges for unified care coordination, but that began changing in July 2023. Point32Health brought all behavioral health services in-house, centralizing management, clinical teams, claims processing, and data management.
“All of behavioral health will be in-sourced to Point32Health, which is really exciting because the whole focus of our program is integrated care,” Borrelli said. “To have all of our clinical teams and our claims, and our data and our call centers, all working on medical and behavioral health at the same time is how we start to treat people holistically.”
Shifting Toward Value-Based Care
Point32Health is also advancing value-based contracting, a model that ties provider payment to clinical outcomes rather than service volume. This approach incentivizes high-quality, evidence-based care, creating a financial structure that rewards effective treatment over quantity of visits.
“We have a few really exciting value-based financial agreements, where we are moving from the volume incentive reimbursement structure to focus more on quality,” Borrelli said. “There are financial incentives for innovative, evidence-based clinical models that produce health outcomes.”
Pioneering Autism Care Programs
Among Point32Health’s most notable initiatives are its autism care programs, which use value-based contracts to improve outcomes for children on the autism spectrum. Partnering with Cortica, the health plan is the first in the country to implement a program where clinical outcomes determine financial incentives.
The partnership covers Massachusetts Medicaid and commercial members and allows Cortica to implement treatment plans based on each child’s acuity level without seeking individual approvals for every intervention. Bonuses are tied to meeting quality metrics, including access and outcome measures.
“We’ve arranged with them that they don’t have to ask us for individual things. They provide the treatment plan, and based on the member’s acuity level, there are different treatment protocols. If they meet their quality metrics, which include both access and outcome, there is a bonus associated with it,” Borrelli said. “We’re excited because this is the first arrangement like this in the country.”
These autism care programs are especially important as autism diagnoses continue to rise, with roughly 1 in 44 children in the U.S. affected. By tying outcomes to evidence-based treatment, Point32Health aims to improve both short-term progress and long-term developmental milestones for children.
Expanding Value-Based Care for Substance Use Disorder
In addition to autism, Point32Health is applying value-based care models to substance use disorder treatment. In 2021, it partnered with Eleanor Health to develop a population health program for Tufts Health Plan Medicaid members.
Borrelli emphasized the reasoning behind this strategy: “By addressing people’s unmet behavioral health needs, ultimately, we’re going to reduce overall medical cost and improve members’ health outcomes. Research shows that someone who is depressed often cannot fully engage in managing other medical conditions due to underlying behavioral health issues.”
This program integrates clinical care management, peer recovery coaches, and therapy services, ensuring that members with substance use disorder receive comprehensive support, including attention to coexisting medical conditions.
Clinical Integration Across Acuity Levels
Point32Health’s value-based care model relies heavily on clinical integration. Behavioral health care management programs provide tiered interventions based on the severity of a member’s condition. Higher-acuity cases, including those with substance use disorder or serious mental illness, receive specialized support from dedicated care teams.
Peer recovery coaches, who have lived experience with behavioral health challenges, work with members to guide them through treatment and recovery. Borrelli explained, “If a behavioral care manager is working with someone with substance use and there’s a medical comorbidity, it’s a quick virtual walk to your neighbor’s desk to consult on the medical piece or engage a medical care manager as needed.”
Point32Health also holds dedicated clinical rounds where behavioral and medical clinicians, including psychiatrists, meet to discuss members with serious mental illness, ensuring timely interventions and integrated care planning.
Virtual Care and Flexibility
Understanding that not all members want traditional care models, Point32Health has expanded virtual behavioral health services. Partnering with Valera Health, the plan provides digital care for children and adults across mild to severe mental illness.
“We want to have a really big menu for people to access care,” Borrelli said. “Maybe care management isn’t right for someone with serious mental illness, but engaging in telehealth with a Valera therapist might get them to the next place. We’re building programs across the acuity spectrum, with different modalities based on where members are.”
Virtual care allows members to engage with therapists, case managers, or peer coaches in a convenient, flexible environment. It complements in-person programs, including the autism care programs, ensuring access for all levels of acuity.
Scaling Autism Care Programs Nationwide
Point32Health aims to expand its autism care programs beyond Massachusetts, creating a model that other health plans may adopt. By establishing clear metrics, leveraging value-based incentives, and emphasizing holistic care, these programs demonstrate how innovative approaches can improve both outcomes and quality of life for children with autism.
“The approach to autism care is really about giving providers the tools and flexibility to focus on quality outcomes,” Borrelli said. “We’re excited to see how this model can be scaled, refined, and replicated to benefit more children.”
Holistic, Whole-Person Approach
Ultimately, Point32Health’s integrated care model prioritizes treating the whole person. Aligning behavioral health, physical health, and value-based incentives allows the health plan to improve outcomes, reduce costs, and ensure members receive care that is both comprehensive and accessible.
“We know that health is interconnected. Addressing behavioral health needs allows members to better manage chronic conditions, attend therapy, follow nutrition plans, and participate in physical therapy,” Borrelli said. “Treating the whole person is the most effective way to achieve meaningful health outcomes.”
Looking Ahead
With integrated clinical teams, value-based contracts, virtual care offerings, and specialized programs, Point32Health is building a scalable, innovative approach to behavioral health. The organization plans to expand its autism care programs and substance use disorder initiatives, while continuing to refine its care models to meet the diverse needs of its members.
Through evidence-based care, financial incentives tied to outcomes, and flexible delivery methods, Point32Health is setting a national example for how health plans can manage behavioral health holistically and effectively.
