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Harvard Pilgrim Tops NCQA Rankings for 4th Year

Margaret Dick Tocknell, for HealthLeaders Media, September 25, 2013

So how does Harvard Pilgrim manage to fare so well year after year?

I had the opportunity a while back to interview Michael Sherman, MD, MBA, Harvard Pilgrim's senior vice president and the chief medical officer. He spoke then about the importance of partnering with provider systems to be "part of the solution" and talked about the innovations such as pay-for-performance, bundled payments, and patient-centered medical homes that the company has supported for several years.

Sherman stressed the importance of shifting physician relationships from a win-lose model, where most payer-provider discussions are about fee schedules, to a win-win model, where payers and providers work together to improve the delivery of healthcare.

That means spending more time talking to physicians about things like their infrastructure needs and developing payment systems that support improved healthcare delivery. Harvard Pilgrim also provides capabilities in analytics and care management programs to support physicians.

The health plan invests not only in outcome-based programs but also provides grants to help physician practices get the tools, develop the infrastructure, and hire the personnel needed to improve care delivery and reduce costs. Over 13 years Harvard Pilgrim has funded more than 190 initiatives totaling more than $14 million in its three-state service area.

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