harvard pilgrim health care 2013 annual report & work together · 2014-04-01 · harvard...
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H a r v a r d P i l g r i m H e a l t h C a r e 2 0 1 3 A n n u a l R e p o r t
&greatideas
inspiredpartners
a m a z i n g
t h i n g s h a p p e n
w h e n p e o p l e
w o r k t o g e t h e r&
our passion is
People ask me all the time, “How is Harvard Pilgrim different?” And I can sum it up in two words – trusted partner.
That is who we are to the doctors, hospitals, employers, members, brokers and others we work with
every day.
It’s also one of the main reasons we are the only health plan to have achieved a full decade as the #1 rated
private health plan in America for member satisfaction and quality of care by the NCQA.*
What makes a trusted partner? Someone who listens, who understands and cares about your point of
view, who is not behind you and not in front of you, but is there with you. Trusted partners are honest and
do what they say they are going to do.
Part of that special partnership approach springs from our heritage as a local, nonprofit plan. Our
employees are your friends and your neighbors, and our employee volunteerism is off the charts —
more than 98% of our employees participate in our community giving or volunteer activities.
But our local focus on the markets and the communities we serve also is having a positive impact across
the entire region. A shining example, covered in the coming pages, is our Foundation’s focus on reducing
childhood obesity and improving health equity for underserved populations.
This year’s report features six of the many stories of how great ideas and inspired partners have come
together to lower cost, improve quality and create a better experience in health care at this time of
such change and opportunity.
Here’s to great ideas, inspired partners and our progress together.
Eric H. Schultz
President and CEO
* NCQA’s Private Health Insurance Plan Rankings, 2011-14, HMO/POS. NCQA’s Health Insurance Plan Rankings 2010-11 – Private. U.S.News/NCQA America’s Best Health Insurance Plans 2005-2009 (annual). America’s Best Health Insurance Plans is a trademark of U.S.News & World Report. NCQA The State of Health Care Quality 2004.
that workpartnerships
my passion is helping people find the
and hope to get healthycourage
Mimi Emerson, R.N., B.S.N., M.S., C.C.M.
Care Manager
Dartmouth-Hitchcock Medical Center
my passion ishonestyWilliam Brewster, M.D.
Harvard Pilgrim
Associate Medical
Director
So what if we partnered with health care leaders to help get costs down and get satisfaction up? That’s ElevateHealth!
Created through a unique partnership of three local nonprofits —
Dartmouth-Hitchcock, Elliot Health System and Harvard Pilgrim Health Care
— ElevateHealthSM is all about improving quality, lowering costs and creating
a better patient experience for the people of New Hampshire.
As RNs at Dartmouth-Hitchcock Medical Center and Elliot Hospital,
respectively, Mimi Emerson and Julie Boyer have become dynamic forces
in their roles as care managers for ElevateHealth members. They wear
many hats on members’ behalf: health advocate and educator, as well as
liaison to a close-knit care delivery team, social services support and
community resources.
“We’re all working very closely together for the patient’s sake, and an
important part of my role is to help ensure all providers — and Harvard
Pilgrim — stay on the same page,” says Emerson. “As part of that, I help
‘connect the dots’ so the care team has the right information at the right time.
And the same goes for patients — I have to ensure they understand the
support system and have access to the right resources, especially when
they’re discharged. That could include local and nationally based extended
support, including special services, even arranging transportation.
“One of the most valuable aspects of ElevateHealth is in the sharing of claims
and medical data between Harvard Pilgrim and the various providers,” adds
Emerson. “That brings the picture all together, which helps us deliver better
care to each patient, while reducing the potential for duplication of tests and
services. And, it helps improve overall population health, because it enables
us to identify trends and find opportunities for improvement.”
“No more silos — that’s one of the key advantages of ElevateHealth,”
says Boyer. “The health plan and providers are really working in synch —
something that doesn’t often happen. And within that partnership,
Harvard Pilgrim’s role is much more than that of a bill payer.
“The tight collaboration and communication within the care delivery team
are vital to better care,” notes Boyer, “and so is my role as a proactive
resource for patients. That includes reaching out to them upon discharge
to address any issues before they turn into real barriers. Just knowing that
we’re available and accessible to help navigate a complicated system can
bring great peace of mind at a difficult time.”
“ElevateHealth is truly a different approach that can make a real impact,”
says William Brewster, M.D., Harvard Pilgrim associate medical director,
“particularly around the pivotal roles care managers play as patient advocates,
clinical team liaisons and promoters of health and wellness among the
patient population. The level of honest, open sharing that we have
experienced has resulted in a transformative relationship between an
insurer and providers.”
ElevateHealth Vital Signs
Description:
Health plans with a network
of high-performing providers,
designed to raise the quality
bar and lower costs in
New Hampshire.
Introduced:
September of 2013 by
founders Dartmouth-Hitchcock,
Elliot Health System and
Harvard Pilgrim; built on keenly
aligned health outcome and
fiscal goals.
Differentiator:
Brings care coordination
back to local, close-knit health
care teams, which is best for
the patient.
Network:
More than 400 PCPs,
2,600 specialists and five
leading hospitals specially
selected for their effectiveness
and quality performance.
Payment model:
A deliberate departure from
the costly fee-for-service
approach rewarding volume,
ElevateHealth rewards
providers based on patient
outcomes and efficiency
of care. my passion is
health care barriers for membersovercoming
Julie Boyer, R.N.
Care Manager
Elliot Health Systems
my passion isengagementDavid M. Harlan, M.D.
UMass Memorial Medical Center
Diabetes Center of Excellence
with my patients’ lives
my passion isinnovationCynthia Rosenberg, M.D.
Harvard Pilgrim
Senior Medical Director
So what happens when a health insurer supports provider innovation? A better patient experience and improved value.
Over the last century, the medical system mastered how to fix a broken bone, take out an appendix and treat pneumonia. But it hasn’t been as effective in treating chronic conditions like diabetes.
In fact, the costs of diabetes are on the rise. The American Diabetes Association estimates that the total costs of diagnosed diabetes rose to $245 billion in 2012 — a 41% increase since 2007.
Dr. David Harlan, chief of the Department of Medicine’s Diabetes Division and co-director of the UMass Memorial Diabetes Center of Excellence, is working with help from Harvard Pilgrim to change that.
Introduced by Dr. Harlan and his colleagues, MyCareTeam Clinical is a groundbreaking online diabetes management system that lets a patient download blood sugar readings from most meters using a secure home Internet connection. The information then is uploaded to the patient’s electronic medical record and the physician gets an alert. Patients can also use the system to send their doctor a secure message.
“It’s a better way to communicate, much more efficient,” says Dr. Harlan. “It saves patients trips to the office and is a better way to feel connected all the time. The meat of the discussion with my patients is always what they’re doing to control their blood glucose.”
Harvard Pilgrim member Christina Lindsey, 29, says the system is easy to use, and her Hgb A1c has significantly improved since she started uploading her meter over a year ago.
“Instead of wondering and waiting for an appointment, now I can see how I’m doing right when I upload my meter readings,” says Lindsey, who has been living with diabetes for 19 years and is eight-months pregnant. “I can see graphs, trends and patterns, and because a copy is sent to the clinic, they can tell me if I need to adjust anything.”
But patient care is just part of the equation. “Historically, providers are paid on a fee-for-service basis — not an ideal payment system for patients with chronic conditions,” says Cynthia Rosenberg, M.D., Harvard Pilgrim senior medical director. Through a Harvard Pilgrim Quality Grant, UMass Memorial and Harvard Pilgrim are developing an innovative way to pay for the total care of these diabetic patients that has better value for all.
“We’re excited to be working with an innovator like Dr. Harlan,” says Dr. Rosenberg. “This will result in more effective collaboration among PCPs and specialists so that they can provide the best possible care for patients. And, this current project builds on work that we have done together in the past related to both diabetes and care coordination.”
The online monitoring of blood sugar readings will help to reduce the need for face-to-face visits and trips to the emergency room, minimize the need for paperwork, and ultimately improve patient satisfaction and outcomes.
“If we are engaging the patients and their providers, of course they’ll do better,” says Dr. Harlan.“It’s just been challenging to figure out a way to do that without adding a ton of work to an already overburdened health care system. I’m convinced that we are on the right track.”
Through its Quality Grants Program, Harvard Pilgrim has funded more than 208 initiatives in the last 14 years with innovative providers across the region.
This program also identifies best practices that other Harvard Pilgrim network clinicians can replicate and is one of the many ways Harvard Pilgrim supports providers in transforming care delivery. Our innovative care delivery models also explore and encourage care for members that improves outcomes, reduces costs and enhances their care experience.
The first successful care delivery models for primary care and specialty medical homes have been joined by bundled payment models with select providers in Maine, Massachusetts and New Hampshire.
Through a bundled payment methodology, a group of providers is paid one amount for an entire episode of care, rather than fee-for-service, encouraging providers to work together more efficiently, communicate more effectively, and focus more on outcomes and the overall patient experience.
my passion is keeping thingssimpleChristina Lindsey
Harvard Pilgrim member
and Layla
my passion isempowering women
Diane Skog
Director of Marketing
and Development
Saint Andre Home
my passion isleading my community
Deqa Dhalac
Human Services Counselor
Survivor of Torture Program
City of Portland
So what if we helped local leaders make health care more equitable in Maine? Yes!
Ensuring that everyone has access to high-quality, culturally appropriate
health care is a major issue and opportunity for our society. The Harvard Pilgrim
Health Care Foundation’s Culture InSight program is helping community
leaders in Maine make health care more equitable for two of the state’s
vulnerable populations. Culture InSight provides cultural competency
training, consulting and organizational development services to providers,
health and human services professionals and their organizations to create
sustainable changes in health care delivery.
Culture InSight worked with the Daniel Hanley Center for Health Leadership
to train graduates of the center’s health leadership development program
as health disparity ambassadors. The ambassadors were asked to launch
projects that will identify and address health disparities in their communities.
In Portland, Hanley alumni Deqa Dhalac and Diane Skog teamed up to
coordinate weekly educational meetings for mothers among the city’s
Somali refugee and immigrant population.
“At work I was seeing a lot of people having a really hard time with the
American health care system,” says Dhalac, a native of Somalia. “They cannot
access anything because of the language barrier and the culture barriers.”
Each week, Dhalac and Skog brought in local health professionals to teach the
mothers in their native language about important child health topics such as
oral health, healthy eating, immunizations and literacy. The meetings also gave
the Somali women a place to socialize and make connections. Some have even
become aspiring child care providers based on what they learned.
“The Culture InSight training was amazing,” says Skog. “One of the most
powerful things I heard was: ‘You know what you know and what you’re born
into.’ It’s something very simple that helped me reframe the way I look at
things.”
As the ambassadors got their projects under way, Dr. Mitzi Johnson and her
team from Culture InSight gave them feedback on and support for their work.
“These are people whose passion is not just verbal,” Dr. Johnson says of the
health ambassadors. “They are putting what I would call sweat equity into
moving the health equity dial forward, even in small ways.”
Farther up the Maine coast, Eastport Health Care CEO Holly Gartmayer-
DeYoung sought to engage the community in a conversation about improving
care for Washington County’s mentally ill.
For patients and their loved ones, a mental illness diagnosis may often come
with a high degree of shame and judgment. For health care practitioners,
For more than 20 years,
Culture InSight has been a
national leader in the field
of cultural competency for
health and human services
professionals and their
organizations. To help
organizations achieve cultural
competency, Culture InSight
offers a range of services,
including organizational
assessments, community
mapping, interdisciplinary
team building, program
design, data analysis and
leadership development.
my passion isequity
Mitzi Johnson, M.D.
Cross Cultural Health
Care Specialist
Culture InSight
women
my passion is compassionate
listeningHolly Gartmayer-DeYoung
CEO, Eastport Health Care
particularly emergency room and primary care providers, there’s often a sense
of helplessness in being able to fully respond to these patients and move
them toward better living and better health.
Using a community circle model based in mindful, intentional listening,
Gartmayer-DeYoung initially convened a group of primary care and behavioral
health providers to start addressing the challenges. The circle grew to include
patient advocates and representatives from local hospitals, law enforcement
and clergy. Patients themselves and Maine legislators have joined as well.
“It’s all in the spirit of listening and then lending a voice to contribute to a
culture shift,” says Gartmayer-DeYoung. “That’s really what’s happening.”
As for her thoughts on Harvard Pilgrim’s support for reducing health
disparities, Gartmayer-DeYoung says that simple thankfulness doesn’t
begin to cover it.
“I’ve never worked with an organization that was so incredibly visionary in
this regard,” she notes.“‘Gratitude’ is not an adequate word to describe
the personal feeling I have for the commitment Harvard Pilgrim has and
consistently demonstrates as it relates to ensuring a conversation about
health equities.”
The admiration is very much mutual, according to Dr. Johnson. “This group
of individuals has been impressive to me in their commitment to addressing
these issues in whatever way makes sense for the population they’re working
with,” she says.“I’m so proud of them, I have to tell you.”
In addition to the Hanley Center’s Health Disparities Ambassador Program,
Culture InSight is supporting four other place-based projects to reduce health
disparities through its Partnering for Healthy Communities program:
• Addressing Health Disparities through a Multi-Stakeholder Collaboration
New Hampshire Health & Equity Partnership
• Infusing Mass in Motion with Health Equity
Mass in Motion
• Improving Pregnancy Care and Early Childhood Visit Rates in the Latina
Community in Lawrence, Massachusetts
Neighborhood Health Plan
• Latino and Brazilian Disparities Project: Organizational Cultural Competence
Advocates, Inc., South Middlesex Opportunity Council and Wayside Youth
and Family Support Network
“ Too often people think
cultural competency is only
for people of color or new
immigrants to the U.S.
In reality there are all kinds
of disparities in many
communities.The disparities
we see in rural Maine differ
from those in an urban
inner-city community, but
they may be equally lethal
in their impact.”
Mitzi Johnson, M.D. Culture InSight
my passion is
my passion is
nutrition
resultsTracy Esperanza, Senior Benefits Analyst, Lahey Health
Sharon DiSalvo, Director of Compensation & Benefits, Lahey Health
So what if a nationally recognized health system had a great idea to improve their employee health, increase health system volume and better control plan costs?
Lahey Health did! And they chose Harvard Pilgrim as their sole health plan partner to
make it happen. Together, we built a tiered network product that encouraged Lahey Health
employee colleagues to choose their medical care within the Lahey Health system and
developed a leading edge, multi-faceted wellness program that is working to make
Lahey Health a healthier organization.
“We trusted Harvard Pilgrim to help us create the kind of tiered network plan we wanted,”
says Sharon DiSalvo, director, compensation & benefits for Lahey Health. ”Not just in terms of
the plan design, but the high level of customer service and support that is needed for success.
The way Harvard Pilgrim helped us roll out the plans was perfect.”
DiSalvo says that solid communications assured Lahey Health colleagues they would receive
excellent care with the utmost of privacy and confidentiality. ”Our benefit plans are designed
to support our employees and are aligned to our corporate strategies. A large number of our
members are coming here to receive medical care.”
The tiered network plans are just part of a comprehensive strategy that included making
progress with an outcomes-based wellness program, another priority for the organization
and its President and CEO Dr. Howard Grant. “Our efforts are to help make Lahey Health
a healthier hospital system so that we’re role models for better health in our community,”
says DiSalvo.
According to Jamesie Gifford, manager of health education at Harvard Pilgrim, it is inspiring
to see Lahey Health’s Live Better program commitment to include its entire community. “They
encourage spouses of colleagues and even volunteers to participate,” she says. “And the scale
of the effort is also very impressive.” The program included more than 60 annual biometric
screenings each fall as well as monthly wellness seminars on topics related to improving
BMI, blood pressure, stress levels or fitness routines. Another unique program element is a
dedicated Lahey Health nurse consultant, who connects health and wellness with medical care.
“She may check in with colleagues after coming home from the hospital, help them identify
the appropriate Lahey Health clinician or guide them to a wellness coach,” says Gifford.
Harvard Pilgrim rolled out an advanced online wellness system in 2013 to further power the
wellness effort. “This technology is a welcome addition to our Live Better program and opens
the door for many new opportunities, including online challenges that can bridge colleagues
who work at different hospital locations,“ says Tracy Esperanza, Lahey Health senior benefits
analyst. “We’re looking forward to how these new tools will add to the success of our program.”
Our efforts are on track and delivering results, and the partnership is a big factor in that success.
“Constant collaboration, quality work and the drive to improve are critical in the changing world
of health care and wellness,” says Esperanza. “What impresses me most is how the Harvard
Pilgrim team works truly for the good of Lahey Health. They always bring the right people to the
table to get things done no matter who I’m working with, or the challenges at hand. I trust that
the quality of work will exceed my expectations every time.”
my passion isactionJamesie Gifford
Harvard Pilgrim
Health Education
Manager
my passion is
Amy Zaganjori
Lahey Health
Employee
I initially participated in the
Lahey Health Live Better
program solely to save money
on my insurance. More than
a year later, receiving the
financial incentive was the least
of the benefits. The Live Better program has truly changed my
family’s life for the better.
Attending the screenings
and seeing the reality of my
numbers was overwhelming,
especially my actual BMI and
off-the-chart hypertension
numbers. I knew I had to do
something, for my baby girl.
Since my husband was in even
a more dire health situation,
he also wanted to take action.
With the support of Lahey
Health’s medical weight loss
program, plus ongoing tips
from my Harvard Pilgrim health
coach, together we have lost
nearly 200 pounds through diet
and exercise.
We still have a ways to go,
but today my blood pressure
is within normal range and I’ve
dropped 10 BMI points. My
husband can now keep up with
our active toddler and take
on bigger home improvement
projects. We’ve successfully
changed our eating habits,
surviving the holidays and our
daughter’s first birthday. Best of
all, we are passing along good
habits to her. She loves her
fruits and vegetables, yogurt
and protein — even flax seed
crackers.
teachingGrace to eat healthy
make healthy decisions
my passion is building
my passion is
within communities
helping families
relationships
Jennifer Bram, M.D.
UMass Memorial Medical Center
Emily Walters, CHES
Let’s Go! Healthcare
MaineHealth
my passion is
of childhood obesity
reversing the curse
Mike Devlin
Harvard Pilgrim Health
Care Foundation
T
So what if we could take a great program in Maine to prevent childhood obesity and make it work in other states? Run with it!
hat’s what pediatrician Dr. Martha Waite did when she was given the
opportunity to help bring Maine’s Let’s Go! Healthcare program to eight
Reliant Medical Group practices in central Massachusetts that serve
pediatric patients.
Introduced in Maine several years ago, Let’s Go! Healthcare partners
with primary care physicians to provide educational outreach, supporting
materials and training on healthy eating and physical activity to prevent
childhood obesity.
It’s been highly successful and effective because it uses simple tools that
providers can use to start a conversation with patients and families about
healthy behavior and weight. Funded by the Harvard Pilgrim Health Care
Foundation’s Growing Up Healthy initiative and implemented in partnership
with MaineHealth, the program was recently expanded to other states.
“We now have 17 champions in three states,” said Emily Walters, program
manager, Let’s Go! Healthcare, MaineHealth. “These are physicians who
work with their peers across the region and are committed to spreading the
Let’s Go! healthy lifestyle message.”
Dr. Waite is now a physician champion for the program. She works directly
with her counterparts in Maine as well as her peers in central Massachusetts.
With support from the Harvard Pilgrim Foundation, she provides monthly
updates to staff from Reliant Medical Group to ensure the program is
successful. “I use it in my own practice,” said Dr. Waite. “For example, the
health questionnaire is a simple tool that helps me identify areas to focus on.
If I see that someone is eating zero fruits and vegetables a day, I can say
‘How about we start with one or two a day?’ That’s something concrete
patients can work on and not get discouraged.”
Pediatricians at UMass are also using the program. Dr. Jennifer Bram,
pediatrician and Let’s Go! champion, is delighted at the simplicity of the
program. “The beauty of the 5-2-1-0 message is that it is easy to remember,”
she says. “People are paying more attention, especially health care providers
who are looking for more structure on how to help prevent childhood obesity.
“The investment that Harvard Pilgrim has made shows a true commitment
to patients, says Dr. Bram.“We need community partners who share our
same values, and we have found that in Harvard Pilgrim.”
Growing Up Healthy is the Harvard Pilgrim Health Care Foundation’s leader-
ship and funding initiative whose goal is to reduce childhood obesity among
children age 6-12 years in Massachusetts, New Hampshire and Maine.
Let’s Go! is a nationally recognized childhood obesity prevention program that
reaches children and families in six settings where they live, learn, work and play.
Let’s Go! is a nationally
recognized childhood obesity
prevention program designed
to increase healthy eating and
active living in children from
birth to 18.
More than 152 provider
practices across Maine, New
Hampshire and Massachusetts
are now participating in Lets Go!
Healthcare. Participants must
meet three basic criteria in order
to be recognized as a Let’s Go!
Site of Distinction:
• Display a Let’s Go! poster
in the waiting room and all
exam rooms where pediatric
patients are seen
• All providers determine BMI
for patients age two years
and older
• All providers use the 5-2-1-0
Healthy Habits Questionnaire
at well-child visits
The 5-2-1-0 messageStrive for these healthy habits
for children every day:
5 fruits and veggies
2 hours or less of recreational
screen time*
1 hour or more of physical
activity
0 sugary drinks, more water
and low-fat milk
* keep TV/computer out of
bedroom. No screen time
under age of two.
my passion is getting kidsmovingMartha Waite, M.D.
Reliant Medical Group
my passion isconnectingDonna Cady, R.N.
Harvard Pilgrim
Oncology Nurse
When patient Starr Hill and Harvard Pilgrim Oncology Nurse Donna Cady met for the first time, their relationship was clear.
my passion issharing Starr Hill
Harvard Pilgrim member
So what would you do if you really needed someone to have your back, and they did? Pay it forward.
Starr Hill has always taken care of herself, eating right and exercising. So when the 48-year-old mother of two experienced recurring stomach pain, it didn’t seem like a big deal. But it was. A visit to her doctor revealed colorectal cancer that had spread, and the road ahead for her was overwhelming.
“We all know that someday we are going to die, and that thought is usually far away, but all of a sudden it was right in my face,” she says.
Starr and her oncologist decided to attack the disease with chemotherapy — delivered in the hospital every 14 days for about six months. As she was preparing mentally and physically to begin, she received a call from Donna Cady, R.N., a Harvard Pilgrim oncology nurse. Donna was alerted by a claims analysis that Starr may benefit from Harvard Pilgrim’s oncology care management program.
“When I first started talking to Starr she didn’t want to know too much,” says Donna. “I respect that. What you need to know is whatever you feel you need to know. Because she was starting treatment, we focused on the symptoms she was experiencing and on finding strategies to manage those side effects.”
“Donna helped me a lot during chemotherapy,” says Starr. “She is a great listener and her sound advice has helped me remember that I am doing OK. I can turn to her with questions and she gets answers for me.” Donna and Starr also talked about how overwhelming it can be to talk to others about an illness. “I was getting many text messages and calls. I was so grateful that people cared so much, but I was also exhausted trying to keep up,” says Starr.
At a friend’s suggestion, Starr started posting online journal entries at Caring-Bridge, a Web site where people with health challenges can post updates for friends and family. “Writing down what she was doing also became a form of therapy for Starr,” says Donna. “And more and more people started sharing with her and supporting her. She learned a lot about herself and it helped her.” Starr also began sharing on Facebook and began focusing on raising colorectal cancer awareness — all while she was undergoing her own treatments.
In March, for a national dress in blue day to raise awareness for colorectal cancer, several of Starr’s friends decorated a local bridal shop window in royal blue in her honor and gave her a blue dress to wear. “I kept saying to everyone, ‘Dress in blue on this day and share your pictures with me,’” she says. “My Facebook page was a sea of blue. It was amazing.”
Starr also started preparing care packages for hospital patients about to begin chemotherapy. “She really has developed and grown a lot in the last year,” says Donna. “Her work to raise awareness and help others has helped her. She has become more active and proactive in her care and now wants to know more about her condition.”
Although Starr’s treatment continues, the positive energy from the community and from Donna has played a huge part in how she is feeling — which is better. “It’s not in my face anymore,” she says. “And when Donna is talking to me, it’s for me and all about me, which is a great thing when you are going through this.”
Navigating your health care can be overwhelming. Harvard Pilgrim nurse care managers help members through their health challenges by:
• Helping follow their doctor’s treatment plan
• Offering tips and resources to help manage their condition, including awareness of possible symptoms and side effects
• Providing a listening ear for physical and emotional support
• Helping communicate better with the doctor and other members of the care team
• Providing information on available community resources
Each year Harvard Pilgrim care managers assist more than 70,000 members with a range of medical conditions, including cancer, diabetes, asthma, heart failure, coronary artery disease and renal disease.
differently Because that’s how you get great ideas.
We believe great ideas can come from anyone, anywhere, anytime — that’s why we take special care to listen.
With more than 10 constituent advisory councils, including a unique online member panel called Harvard Pilgrim
Listens, we constantly engage to seek out new ideas. But taking great ideas and making them a reality is hard to
do, and it always works best when you have passionate, dedicated partners to focus on them together.
In addition to the stories we’ve already featured in this report, I would like to share the following partnerships
and great ideas happening right here within Harvard Pilgrim’s own walls.
Thanks for your support as we improve the value and quality of health care for the communities we serve —
from Connecticut to Maine to Massachusetts to New Hampshire and beyond.
Eric H. Schultz
Eastern Harmony — the best of eastern and western medicine
In 2013, Harvard Pilgrim unveiled its Eastern Harmony
program that combines the traditions of western
medicine with those of China and India — like
acupuncture, ayurvedic practices, herbal medicine
and mindfulness.
Eastern Harmony is now available to employers who
want to offer greater access to alternative health care
approaches. While Eastern Harmony is benefiting
Chinese and Asian Indian employers who told us they
have long been looking for this kind of option, it also
has expanded choice for our members at large.
Harvard Pilgrim also announced the launch of Count
Us In Community Partners in 2013: a year-long
partnership with the Asian American Civic Association
and Saheli Boston — nonprofit organizations working
with the Chinese and Asian Indian communities
respectively.
The Asian American Civic Association has served
and advocated for the needs of immigrants and
other economically disadvantaged people since
1967. Saheli Boston is the only nonprofit organization
specifically providing support services, training
programs and recovery resources to South Asian
American women affected by domestic violence
and abuse.
my passion isengaging people
Eric H. Schultz
President and CEO
Harvard Pilgrim
differently
Who we are
Harvard Pilgrim Health Care is one of the
nation’s leading not-for-profit health plans.
Our passion is to make health care work
better for the people and communities
we serve. We collaborate with members,
doctors, employers and brokers to offer
innovative, customized health and
benefit solutions, delivered with exceptional
service, all with the goal of improving value
and quality across the health care system.
Visit us at www.harvardpilgrim.org/annual
for information about our leadership and
more details of what we’ve been up to.
Count Us In Community Partners is providing
sponsorship and grant support to build each
organization’s capacity to enhance its services. In
addition, each agency is receiving volunteer support
from Harvard Pilgrim employees, promotional assistance
and an opportunity for participation in mentorship
programs with Harvard Pilgrim’s senior leaders. The
new partnership’s purpose is to help local nonprofits
maximize their services and engage Harvard Pilgrim
more directly with the region’s diverse communities.
These initiatives are part of Harvard Pilgrim’s newly
established Center for Inclusion Initiatives. Led by Vice
President and Chief Inclusion Officer Karen Young,
the Center represents a company-wide, comprehensive
commitment to inclusion at the forefront of everything
Harvard Pilgrim does. We define inclusion as valuing
difference and creating value through difference each
day — with one another, with our customers and in the
community.
Under the center’s umbrella, Harvard Pilgrim established
six tracks intended to deliver on its inclusion business
strategy. The tracks include marketplace connection,
workforce development, supplier and vendor contract-
ing, health care equity, community engagement and
enterprise leadership. Harvard Pilgrim has surrounded
these tracks with robust thinking, staff resources and a
determination to get results.
The Harvard Pilgrim Health Care Institute — putting science to work for the communities we serve
The Harvard Pilgrim Health Care Institute’s Department
of Population Medicine is a unique collaboration
between Harvard Pilgrim and Harvard Medical School
that focuses on improving health care delivery and
population health through innovative research and
teaching.
The Institute was created in 1993 and is the only
appointing medical school department in the United
States based in a health plan. Led by Richard Platt, M.D.,
M.S., the Institute’s staff includes leading physicians,
researchers, clinicians and public health professionals.
In 2013, the Institute was awarded a $9 million grant
from the Patient-Centered Outcomes Research
Institute to lead a consortium to serve as the
coordinating center for a new national data network.
The network will enhance the nation’s ability to
conduct patient-centered comparative effectiveness
research and provide patients and providers with
better information to guide their decisions.
The Institute also currently serves as the coordinating
center for the FDA Mini-Sentinel program, monitoring
the safety of FDA-regulated medical products through
a network of electronic health care databases.
Research conducted by Institute staff is shared with the
public, patients, clinicians, government agencies, policy
makers and other health care leaders, and has been
featured in leading peer-reviewed publications as well
as news outlets throughout the world. Here are a few
examples of some of the Institute’s recent studies
showing that:
• Using anti-microbial soap and ointment for all
intensive care patients significantly cut bloodstream
infection, suggesting a major change in health care
practice that could save lives.
• Interventions both before and soon after birth may
be especially effective in preventing obesity.
• One quarter of consumers underestimate fast food
meals by 500 or more calories, indicating that menu
labeling combined with educational outreach may
help consumers understand calories better and
make healthier food choices.
• While breast magnetic resonance imaging use
expanded rapidly in the first decade of availability,
the patients who had the most identifiable need for
the test, especially those at very high risk for breast
cancer, were not necessarily the ones receiving it.
Virtually all of the Institute’s $39 million annual budget
is externally funded, primarily by the Food and Drug
Administration, the National Institutes of Health, the
Patient-Centered Outcomes Research Institute, the
Centers for Disease Control and Prevention, and the
Agency for Healthcare Research and Quality.
Given our nation’s focus on improving health care
quality and reducing health care costs, the Institute’s
collaborative work with health plan members, patients,
providers, leaders and government agencies is more
relevant and important than ever before.
Health Plans, Inc., is New England’s leading administrator of self-funded benefit plans and a Harvard Pilgrim company
In 2005, Harvard Pilgrim acquired Health Plans, Inc.,
a large regional-based third-party administrator (TPA).
With more than 30 years of experience in the TPA and
self-insurance industry, Health Plans serves more than
165,000 members through a diverse set of employer
markets including hospitals, manufacturing firms,
labor unions, municipalities, media outlets and retail
food chains, among others.
After the acquisition of Health Plans, Harvard Pilgrim
leveraged the flexibility and affordability of a TPA-style
administration, along with the power of Harvard
Pilgrim’s extensive provider network and widely
recognized commitment to service and quality.
Today, Health Plans is the leading TPA in New England
and is uniquely positioned to offer attractive, innovative
product designs to employers seeking to provide an
affordable yet comprehensive benefits package to their
employees. Health Plans also offers powerful, custom-
ized plan designs and state-of-the art reporting systems.
Health Plans’ membership revenue and profit have
more than doubled since the company was acquired by
Harvard Pilgrim. Much of the impressive growth can be
attributed to Health Plans’ reputation as the premier
hospital benefit administrator in New England. Case in
point: In 2005 Health Plans served four hospital clients.
Today, Health Plans acts as the TPA for more than
20 hospitals throughout the region.
Health Plans is constantly striving to broaden its
offerings. Most recently, the company managed the
acquisition of MedWatch, a Florida-based medical
management company presenting care management
services to self-insured employers and third-party
administrators nationwide. MedWatch, a URAC-certified
medical management company, offers a full spectrum
of care management programs, including case
management, disease management and utilization
review.
2013 Financials Harvard Pilgrim Health Care, Inc. and Affiliates (unaudited)
Combined Statutory Statements of Revenue and Expenses
For the years ended December 31, 2013 and 2012 ($ in thousands)
2013 2012
Revenue - Premium Income $2,632,821 $2,660,539
Operating Expenses
Medical Costs 2,249,193 2,278,419
Claim Adjustment Expenses 80,930 82,995
General Administration Expenses 301,522 293,928
2,631,645 2,655,342
Underwriting Income 1,176 5,197
Other Income and (Expenses)
Net Investment Income 22,889 24,638
Interest Expense (3,737) (4,432)
Other (521) (2,950)
18,631 17,256
Net Income $19,807 $22,453
Combined Statutory Balance Sheets
As of December 31, 2013 and 2012 ($ in thousands)
Assets 2013 2012
Cash and Securities $845,222 $872,928
Net Premiums and Other Receivables 122,658 112,487
Net Fixed Assets 41,072 41,562
Intangible Assets 4,784 5,739
Other Assets 39,971 25,446
Total Assets $1,053,707 $1,058,162
Liabilities and Net Worth
Liabilities
Claims Payable and Accrued Medical Incentive Pool $220,603 $249,203
Accounts Payable and Accrued Expenses 173,997 189,450
Premium Received in Advance 63,190 50,679
Other 34,659 37,061
Total Liabilities 492,449 526,393
Statutory Net Worth 561,258 531,769
Total Liabilities and Net Worth $1,053,707 $1,058,162
Harvard Pilgrim Health Care Mission
To improve the quality and value of health care for the people and the communities we serve
Core Values
Integrity
We treat others fairly and honestly — the same way we would want to be treated.
Trust
We collaborate and build trust through open, honest and respectful communication.
Innovation
We find creative, new ways to bring value to the marketplace.
Excellence
We expect the best from ourselves and strive to maximize value and service for our constituents.
Inclusion
We value difference and create value through difference.
Community
We make a positive difference in the communities we serve.
People
We succeed by building a talented workforce and caring about our employees and their families.
Accountability
We do what we say we will do and lead by example.
Another creative partnership: Editorial: Harvard Pilgrim Marketing Communications | Design: Yellow Inc. | Photography: Webb Chappell | Printing: Universal Wilde
Harvard Pilgrim Health Care Foundation
93 Worcester Street, Wellesley MA 02481
Harvard Pilgrim Health Care Institute
133 Brookline Avenue, Boston, MA 02215
Health Plans, Inc. Headquarters
1500 West Park Drive, Suite 330
Westborough, MA 01581
MedWatch, LLC
120 International Parkway, Suite 220
Lake Mary, FL 32746
Harvard Pilgrim Health Care
Connecticut
185 Asylum Street, 2nd Floor, Hartford, CT 06103
Maine
1 Market Street, 3rd Floor, Portland, ME 04101
Massachusetts
93 Worcester Street, Wellesley, MA 02481
1600 Crown Colony Drive, Quincy, MA 02169
427 Main Street, Suite 200, Worcester, MA 01608
New Hampshire
650 Elm Street, Suite 700, Manchester, NH 03101
1.888.888.4742
www.harvardpilgrim.org
Harvard Pilgrim Health Care includes Harvard Pilgrim Health Care, Harvard Pilgrim Health Care of Connecticut, Harvard Pilgrim Health Care of New England and HPHC Insurance Company.
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