Managed Care - March 2008 - (Page 15) PILGRIM SO GOOD? PHOTOGRAPH BY WEBB CHAPPELL Doctors are appreciative as well, says Roberta Herman, MD, HPHC’s chief medical officer, who adds that the health plan’s beginnings as the staff-model Harvard Community Health Plan fostered an understanding of the challenges that physicians’ face. “Our history is such that we used to be both a health plan and a delivery system,” says Baker. “Not just Charlie Baker, but many people in the company have at least some history of functioning on the provider side. That is definitely an asset.” Trend setter That history helps HPHC obtain good outcomes, Herman says. “We were doing pay for performance before anyone was calling it pay for performance. Nobody had invented the term, but in effect what we were doing was creating incentives and bonuses for practices that were all-stars to continue doing what they were doing.” The insurer conducts an “honor roll” ceremony every year for high performing physician practices. “On our Web site, we note those practices that consistently achieved excellent results. Each year we have a big bash and we give them honors. We go to the town that they’re in and make sure that there’s a lovely newspaper article The fact that highly rated Massachusetts health plans are all not-forthat acknowledges that they’re on our profit does not mean that what they do cannot be duplicated by a honor roll. They really appreciate that.” for-profit plan, says Charlie Baker, CEO of Harvard Pilgrim Health Care. Baker joined HPHC in the middle of 1999, a year in which the plan ultimately lost $225 million. In 2000, his first full year as CEO, ting out the clearinghouses wherever we could. In the plan lost $9 million. It has been profitable ever the end, we still use them with some providers, but since, and will report $46 million in net income for not many, and we don’t pay a click charge.” 2007. (See “Increased Membership, Revenue” on Employers, while monitoring costs, appreciate a page 14.) Baker believes that Harvard Pilgrim’s atsmooth processing operation. “High-performing tempt to reduce the hassle factor for network physihealth plans are more likely to have organized syscians contributed to the turnaround. tems or system-like elements,” says Helen Darling, Between serving as the Massachusetts secretary president of the National Business Group on of human and health services and going to Harvard Health. “They constantly evaluate, measure, monPilgrim, Baker ran the Harvard Vanguard Medical itor, and manage care and administrative systems.” MARCH 2008 / MANAGED CARE 15
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.