Managed Care - March 2008 - (Page 16) TOUGH NEIGHBORHOOD H arvard Pilgrim Health Care is in one of the most competitive markets in the nation. Blue Cross Blue Shield of Massachusetts, Tufts Associated Health Maintenance Organization, and Fallon Community Health Plan all score well on health care performance evaluations. “Massachusetts, Boston in particular, is the site of some incredibly great health care organizations, and over many years, as health plans have grown and developed, they have adopted those characteristics and they have to compete in that sort of a market,” says David Stefan, the executive director of J.D. Power & Associate’s health care practice. “They have to be extremely good.” Harvard Pilgrim Health Care was the number one commercial plan in America in a joint ranking by U.S. News & World Report and the NCQA. NCQA’s top 5 Health plan and coverage area Harvard Pilgrim Health Care Massachusetts, Maine Tufts Associated Health Maintenance Organization Massachusetts, New Hampshire, Rhode Island Harvard Pilgrim Health Care of New England New Hampshire Blue Cross Blue Shield of Massachusetts Massachusetts ConnectiCare Connecticut Score 91.7 Associates physician group. “I spent an extraordinary amount of time, and our organization was spending an extraordinary amount of time, dealing with ‘administrivia,’” he says of his time at Harvard Vanguard. “When I went to Harvard Pilgrim, my reaction was that if my experience as a leader of a physician group is any indication of what life in a physician group is like, we lose a lot of time that could be a lot better spent for value-added activities. I saw all the time being lost to followup issues concerning benefit management, claims activities, referral authorizations, and payment denials.” 90.8 90.6 89.0 88.9 Source: National Committee for Quality Assurance and U.S. News & World Report, 2007 Harvard Pilgrim also scores consistently high in the J.D. Power & Associates ranking. Harvard was number one in member satisfaction in the northeast region last year. J.D. Power’s member satisfaction index for the Northeast Harvard Pilgrim Health Care Tufts Associated Health Plans Highmark Anthem Excellus BlueCross BlueShield Note: Based on a 1.000-point scale. Source: J.D. Power & Associates, National Health Insurance Plan Member Satisfaction Study, 2007 785 771 762 759 757 Time well spent “We’ve been told by folks in the provider community,” Baker adds, “that the fact that they don’t have administrative and operational issues with us that they need to spend time working through and managing and fixing means that they can spend that time on things like how they’re doing on diabetes, how they’re doing on smoking, and how they’re doing on asthma.” Not everyone thinks that Harvard Pilgrim is kind to doctors (see “This Doctor Begs to Disagree,” on page 22). Even Baker has to pause when he’s congratulated for running a “provider-friendly” company. “The conclusion you can draw is that we don’t drive a hard bargain and we’re not tough in negotiations,” he says. “I would argue that we drive as hard a bargain and we’re as tough as anybody. But we do start with the fundamental premise that there are dozens if not hundreds of transactions that involve us and most of the providers in our network every day and every week. They’re part of doing business with a trading partner, almost.” HPHC plays in a competitive league. Tufts Associated Health Maintenance Organization, one of Harvard Pilgrim’s competitors, has been consistently ranked number two by the NCQA. Blue Cross Blue Shield of Massachusetts, and Fallon Community Health Plan also score well. (See “Tough Neighborhood” on page 16.) 16 MANAGED CARE / MARCH 2008
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