Managed Care - March 2008 - (Page 14) WHAT MAKES HARVARD It’s the nation’s leader in member satisfaction and quality of care, according to NCQA. Dynamic leadership and dominance of a region where excellent docs and plans abound are part of the formula. America by U.S. News & World Report and the National Committee for Quality Assurance. They say that Harvard Pilgrim leads the country in member satisfaction and quality of care. bout 25 years ago, Toyota introduced a Meanwhile, J.D. Power & Associates lists Harvard quality control system that revolutionPilgrim number one in member satisfaction in the ized manufacturing. Some 70 years beNortheast region. J.D. Power’s National Health Infore that, Henry Ford unveiled the first surance Plan Satisfaction Study gave Harvard Pilassembly line. There are moments in every indusgrim a satisfaction index of 785 — the highest score try that are indisputable turning points. of any plan in the nation — out of a possible 1,000. However, most successful companies rise and The study identifies coverage and benefits; choice rise some more by doing the things everybody else of doctors, hospitals and pharmacies; and infordoes, except much better. That’s the not-so-secret mation and communication as the most significant secret of Harvard Pilgrim Health Care. The insurer factors driving member satisfaction. is ranked the number one commercial plan in “We focus intensely on a lot of our operational stuff,” says Charlie Baker, HPHC’s CEO, citing one of his reasons for his plan’s arvard Pilgrim Health Care lost $225 million in 1999, the year success. CEO Charlie Baker came to the struggling plan. He eliminated As a small example, many about 2,000 jobs, overhauled senior management, withdrew from health plans and providers use the Rhode Island market, reworked contracts with the plan’s hospital and physician networks, and changed pharmacy benefit manclearinghouses like WebMD to agers. Things began to turn around for the health plan in 2001. connect electronically with one another to do member eligibility, Healthy trends for Harvard claims processing, and a host of Income from Membership premiums (billions) [bars] other administrative transac(thousands) [line] tions. “The typical fee for this 3.0 1,200 service is a click charge — paid 2.5 1,000 by the plan each time a provider sends a query or a claim to the 2.0 800 clearinghouse for processing, like a toll on a toll road,” says 1.5 600 Baker. “The click charge varies in price, but it’s usually some1.0 400 where between 25 and 50 cents. We decided a few years ago to 0.5 200 build an online and direct transaction capability for use by our 0 0 2001 2002 2003 2004 2005 2006 2007 2008 provider partners, thereby con(projected) necting directly with them, and Source: Harvard Pilgrim Health Care for all intents and purposes, cutBy Frank Diamond Managing Editor A H INCREASED MEMBERSHIP, REVENUE 14 MANAGED CARE / MARCH 2008
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