At Harvard Pilgrim, we recently unveiled a new venture called Access America.  it’s a creative approach to providing our employers who have employees located in other states the door to an extensive national health care network no matter where in the country you are located. From Boston to Berkeley and everywhere in between, Access America has you covered. The new plan builds on our successful, seven-year alliance with United Health care.  Members will enjoy Harvard Pilgrim’s nationally renowned benefits and service, combined with United Health care’s network of more than 650,000 doctors and 5,000 hospitals nationwide. For multi-state employers, Access America is a real win.

Setting health insurance rates is always a challenging proposition that is influenced by a number of factors. For instance, insurers across the nation have seen a major reduction in the use of medical services.  Why?  Most likely due to the weak economy because people are either afraid to take time off from work or they can’t afford higher out of pocket costs.  At Harvard Pilgrim, our goal is to set rates that in line with the medical costs while also providing the best value for our members.  In fact, we recently lowered our rates for April 1 when new information became available to us.  As a not for profit health plan, we’ve always been committed to setting rates that accurately reflect our costs and this will continue to be our promise.

Recently, there’s been talk of limiting the amount of financial reserves that Massachusetts health insurers are allowed to carry. While this may sound like a good idea, it’s not; reserves provide a safety net that ensures hospitals and physicians get paid and consumers are protected in the event of a disaster, widespread illness, or catastrophic event. While we hope that these things never happen, if they do, health plans need to be prepared to respond. In Massachusetts, our highly-rated health plans have reserve levels that are both responsible and proven. The legislators should protect these resources so they can continue to serve as a financial safety net for all of us.

While obesity remains a major public health issue, researchers at our Harvard Pilgrim Institute brought us some good news this week from a regional study that shows declining obesity rates in very young children. Finally, the hard work from innovative public and private programs is beginning to pay off. All involved throughout our community are to be congratulated, including folks at our Harvard Pilgrim Institute and Foundation where obesity prevention has been our top priority. Much good work has been done yet more still needs to be done. This is one of the many reasons we are proud to sponsor Mayor Menino’s “Boston Moves for Health” initiative. It’s the kind of community engagement program we need to keep us on track.

Last week, the special Commission on Provider Price Reform put a spotlight on the problem of high prices charged by hospitals and physician groups that wield excessive market power.  They recommended a series of strategies to fix this major cost driver.  Economics tells us that in a well-functioning market, prices will vary depending on the value of the product or service we purchase.  For example, some people are fine purchasing a $5,000 used car and others want a new $35,000 electric car.  In either case, we know the value of our choice.  That’s not always the case in health care.  Some health care providers charge much higher prices that others and it’s often not based on higher quality but on market power from brand name or geographic location.  If we expect to make a dent in rising costs, we simply have to deal with this problem.  The Commission on Provider Price Reform is only the latest to tell us so, and it is our hope elected leaders will implement their recommendations.

At Harvard Pilgrim, we’re working with physicians to develop new care delivery models.  This collaborative effort aims to improve patient care, streamline decision making and take waste out of the health care system.  One program focuses on Orthopedic care.  When working closely with physicians and hospitals, we see real opportunity to improve quality and reduce costs.  We put the Orthopedic surgeon at the center of the care team, who coordinates all services based on what is best for the patient.  Our strategy looks at the complete suite of services before, during and after an Orthopedic surgery.  And, based on results, we’ll expand this Orthopedic program into other surgical specialties across New England.  The innovations will save employers money, help keep patients healthier, and improve the physician-patient experience, keeping us all focused on making health care work better.

Click here to listen to Eric’s announcement

*HMO/POS. NCQA’s Private Health Insurance Plan Rankings, 2011-12 – 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.

Click here to listen to Eric’s radio segment on Municipal ChoiceNet

Important Information
The Municipal ChoiceNet Plan includes a tiered provider network. In this plan, members pay different levels of cost sharing depending on the tier of the provider delivering a covered service or medical supply. A provider’s benefit tier may change annually on January 1. Please consult the Harvard Pilgrim ChoiceNet provider directory or visit the provider search tool at www.harvardpilgrim.org/choicenet to determine a provider’s tier in the ChoiceNet network. You also may call Harvard Pilgrim to request a paper copy of the provider directory.

Today Harvard Pilgrim Health Care released its 2010 Annual Report – Making health care work better…that’s what we do. I start the report by offering up the three words that come to mind when I think about health care — complex, expensive and personal. We all have different points of view and roles to play in making our system work better for everyone. What are your thoughts and ideas on how health plans, employers, public officials and other health care stakeholders can better collaborate to both lower health care costs and improve quality of care?

“SaveOn helps inform our employees about the cost of care,” explains Connie Roy-Czyzowski, Vice President, Human Resources for Northeast Delta Dental. “It rewards them for making a good decision. And it addresses the broader cost of care in the provider community.” Find out how it works.

Download the complete 2011 Annual Report here.

Download our 2011 Financial Performance here.

Learn more about who we are and what we’ve been up to.