Winning Strategies – Harvard Pilgrim Strives to Increase Presence in Western Mass.

“It’s important because studies show there is a significant difference (in price) with no difference in the quality of the service; an MRI can vary from $500 to $2,500, depending on where it is done,” said Vincent Capozzi, senior vice president of Sales and Marketing for the company. “The program allows people to save money for out-of-pocket expenses and also saves employers money. It has been very successful.”

SaveOn gives members the option of calling a toll-free number for any non-emergency outpatient procedure, which Capozzi said can range from colonoscopies to mammograms, lab work, bone-density studies, ultrasounds, or CAT scans.

Massachusetts subscribers can use SaveOn five times a year and are connected to a nurse, who tells them which accredited plan providers in their area have the lowest cost for the service prescribed for them. The nurse also helps to schedule appointments and fill out any necessary paperwork.

However, the program is completely voluntary, and members have the choice of whether or not they want to use it each time a procedure is suggested. But if they do make the call and choose to go to the location the nurse suggests, they earn cash rewards that range from $10 to $75, depending on the service. If they are already scheduled at a low-cost provider, they receive $10 just for making the phone call. Capozzi said Harvard Pilgrim’s provider network is extensive, continues to grow, and includes more than 135 hospitals and 28,000 doctors and clinicians.

Another Harvard Pilgrim program, called Now I Know, is especially helpful for people with high deductibles.

Information is customized to each member, who can compare the cost of deductibles and out-of-pocket expenses as well as the quality of more than 700 procedures and specialists. It includes the cost of office visits, diagnostic tests, and surgery, along with data about specific diseases and maps that make it easy for subscribers to find physicians and hospitals in their area where they can receive inpatient and outpatient care.

“Our desire and passion to do things like this helps our members,” Capozzi said.

To that end, Harvard Pilgrim Health Care created a unique collaboration in 1993 with Harvard Medical School called Harvard Pilgrim Institute’s Department of Population Medicine. Its staff is made up of physicians, researchers, clinicians, and public-health professionals who conduct research to determine what treatments are best, how to improve the quality and cost of clinical care, how data can support public health, and the impact of financing and administering healthcare insurance.  The institute is the lead organization in the Centers for Disease Control Prevention Epicenter Program, which is a nationwide effort to develop and test innovative approaches to reduce infections in healthcare settings.

Harvard Pilgrim, based in Wellesley, is the largest regional healthcare plan in New England, insuring 1.2 million people in Massachusetts, New Hampshire, Connecticut, and Maine. Although it has never had a strong presence in Western Mass., it has begun to make inroads into the marketplace, especially along the I-91 corridor.

“We opened a Worcester office a few years ago and a Connecticut office last year and started selling there in July. We were very successful, and as a byproduct of our expansion in Connecticut and Worcester, we are now focused on Western Mass.,” said Capozzi, adding that marketing campaigns have been created to raise awareness about the company and the awards it has earned.  “We’ve sold more to small groups there in the last three months than in the last three years.

“What makes us successful is our desire to satisfy our customers,” he went on, “and we have received more recognition than any other healthcare company in the country in the last 12 years.”

The company is continually striving to come up with new initiatives. As an example, Capozzi cited an online program launched last October called EatRight Rewards. It allows members to check the nutritional value of more than 100,000 food items, which are assigned a score from 0 to 100. They can add items in their shopping carriage to a list on a phone app, computer, or tablet, and when they check out, an overall score is determined. Stop & Shop is participating, and Capozzi hopes Big Y will soon join the program.

It’s important because consumers sometimes make incorrect assumptions about the nutritional value of foods.

“When I go before groups, I often ask how many people eat Lucky Charms; although many say they do, the nutritional value of the cereal is only 12,” said Capozzi, citing just one example. “And not all yogurts are healthy, either.”

The program is designed to help people start thinking about choices they make on a daily basis that affect their health.

“If people eat healthy foods, they will become healthier, which will result in lower healthcare costs,” Capozzi told HCN. “And reams of research show that, the healthier employees are, the more productive they are. More than 300 employers are participating in the program.”

He said Pilgrim Health Care has also taken an aggressive approach to improving the quality and cost of its insurance, and cited an instance in which the company went against the medical community to establish a new program.

“In early 2000, we created the first deductible HMO,” said Capozzi. “It was so radical that we had to go before the insurance commission in late 2001 to launch it, but we needed to find a way to help reduce costs for small and mid-sized businesses. Tufts and Blue Cross testified against us, along with the Mass. Medical Society and the Mass. Hospital Association. But, fortunately, the insurance commissioner approved the plan.

“One of the key points is that, even though it involves more cost sharing, we have been able to maintain a better level of satisfaction than our competition,” he went on, referring to a 2012 survey by the Massachusetts Hospital Assoc. (MHA) reporting that Harvard Pilgrim was the clear leader overall among healthcare providers. Roughly 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the 27 acute and two non-acute hospitals or healthcare facilities that provided feedback on health-plan performance gave it an A or B grade, and it did not receive any failing grades.

• The “Number One Health Plan in America” from 2004 to 2013 by the National Committee on Quality Assurance;

• One of the “Top 10 Area’s Largest Corporate Charitable Contributors” for seven out of eight years from 2007 to 2014 by Boston Business Journal’s Corporate Philanthropy Summit;

• “The Best Place to Work” in 2014 by the Human Rights Campaign, who gave it a 100{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} rating on its annual Corporate Equality Index; and

• “One of the Top Places to Work” by the Boston Globe from 2009 to 2014.

“In the last five years, we have been considered one of the most innovative plans in the area. We created a high-performance network with some of the best providers that is cost-effective and saves employers 10 to 15{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in premiums,” Capozzi said, adding that the MHA also ranked it as the number-one healthcare provider in terms of ease of doing business.

Capozzi says 90{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all Massachusetts residents can buy insurance from Harvard Pilgrim, and benefits include a free pair of glasses or discount on designer frames, along with a $150 annual reimbursement to subscribers who belong to a health club for at least four months.

“We sell to individuals who call us directly or find us through the state health connector. We also have other distribution channels, which include e-health insurance, as well as a number of Medicare products for groups and individuals,” he noted.

“We cover people from the time they are born throughout their entire lives and can provide them with independent, third party research,” Capozzi went on. “So we are very excited about becoming a more viable and visible health insurer in Western Mass.”