Managed Care - March 2008 - (Page 20) “In Massachusetts, the market is very blessed by having four plans that are nationally very highly ranked on performance measures like NCQA, and customers don’t usually use the ranking system in selecting a plan,” says Chris Murphy, a spokesman for Blue Cross Blue Shield of Massachusetts. “Part of that is because all four local plans all rank so high.” Harvard Pilgrim’s other competitors declined to comment for this article. Dale Magee, MD, a gynecologist and president of the Massachusetts Medical Society, says that in general, Harvard Pilgrim is a reasonable negotiator. “HPHC has an imaging preauthorization program that we have been working on with them for a few years to decrease the burden on physicians who have good records for ordering appropriate imaging tests,” says Magee. “They have moved to exempt some physicians from the preauthorization program.” However, the reason Harvard Pilgrim and other Massachusetts health plans excel has to do with the level of doctor care, he insists. “If you ask most physicians why they take good care of their pa- tients, I don’t think many will say it’s because the plan has made it easier for me to do so.” Baker responds, however, that it’s not just a case of the doctors making the health plan look good. Harvard Pilgrim’s New Hampshire plan also scores high. That’s not to say that the doctors in Massachusetts are better than the ones in New Hampshire. “My point is not about comparing physicians,” says Baker. “I’m referring to the fact that some people say it’s not the plan, but the network that matters, and reference the fact that HPHC, Tufts, Blue Cross Blue Shield and Fallon all do well on HEDIS in Massachusetts using more or less the same network. Yet in New Hampshire, where we compete against Anthem and Cigna, we still deliver very high clinical scores — much higher than our competitors — with a different provider network. Magee does concede that, in general, HPHC’s high rank helps physicians. “The flip side of winning the competition, which is what these rating systems are for them, is that we as physicians will TRYING TO KEEP IT SIMPLE ith apologies to the memory of Winston Churchill, it could be argued convincingly that the world would almost certainly be worse off if journalists ran it. However, if those world-running journalists were talented (or availed themselves of talented copy editors), then at least everybody would be able to understand one another as civilization sank into the abyss. Charlie Baker, CEO of Harvard Pilgrim Health Care, wrote for his local newspaper when he was in high school and college. He’s one CEO who maintains a blog (and found, as do many who undertake a Web log, that it eats up much more of his time than he’d every dreamed it would). Every Friday afternoon, Baker sends out an e-mail message to employees in what he calls a “casual” style, without the OK of Harvard Pilgrim’s lawyers. He doesn’t like jargon, and he believes W mitted to intellectual rigor when that this impulse helps his comyou communicate, but you don’t pany. have to write in such a way that no “Everybody in health care is one can understand it. guilty of using way too much jarThat philosophy underlies gon,” says Baker. “We’re how HPHC communicates probably as guilty as anywith consumers, says body, though we do try Roberta Herman, MD, to use less of it than most. HPHC’s chief medical officer. That’s a pet peeve of “With our diabetes program, mine. We have tried to a big part of what made us significantly improve the very effective is that we language in a lot of our Harvard have in general used very communications to proPilgrim has an viders.” edge because simple language and we To everybody, in fact. it adopted new have boiled down what it is that the member needs to Baker’s e-mail is about care-related “what’s going on with the strategies well do to take care of him- or before its com- herself. Maybe three to five plan, what’s going on petitors, says critical steps. We created a with the market, what’s CMO Roberta little wallet card. Here are going on operationally, Herman, MD. the three to five questions what’s going on finanwhen you go to your doctor cially, what’s going on with policy.“ It’s written in plain that you should be asking in order English. The message that he to make sure that you’re taking the best possible care of yourself and sends to everybody in the organigetting the care that you need.” zation is that you need to be com- 20 MANAGED CARE / MARCH 2008
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