1. Harvard Pilgrim Health Care 2013 Annual Report
great
ideas
amazing
things happen
when people
work together
inspired
partners

2. partnerships
our passion is
that work
People ask me all the time, “How is
Harvard Pilgrim is different?” And I can
sum it up in two words – trusted partner.
That is who we are to the doctors, hospitals, employers, members, brokers and others we work with
every day.
It’s also one of the main reasons we are the only health plan in our nation to have achieved a full decade
as the #1 rated private health plan in America for member satisfaction and quality of care by the NCQA.*
What makes a trusted partner? Someone who listens, who understands and cares about your point of view,
who is not behind you and not in front of you, but is there with you. Someone who is honest and does what
they say they are going to do.
Part of that special partnership approach springs from our heritage as a local, nonprofit plan. Our
employees are your friends and your neighbors, and our employee volunteerism is off the charts –
more than 98% of our employees participate in our community giving or volunteer activities.
But our local focus on the markets and the communities we serve also is having a positive across the entire
region. A shining example, covered in the coming pages, is our Foundation’s focus on reducing childhood
obesity and improving health equity for underserved populations.
This year’s report features six of the many stories of how great ideas and inspired partners have come
together to lower cost, improve quality and create a better experience in health care at this time of such
great change and opportunity.
Here’s to great ideas and inspired partners and our progress together.
Eric H. Schultz
President and CEO
* NCQA’s Private Health Insurance Plan Rankings, 2011-14, HMO/POS. NCQA’s Health Insurance Plan Rankings 2010-11 – Private. U.S.News/NCQA
America’s Best Health Insurance Plans 2005-2009 (annual). America’s Best Health Insurance Plans is a trademark of U.S.News & World Report. NCQA
The State of Health Care Quality 2004.

3. courage
my passion is helping people find the
and hope to get healthy
Mimi Emerson, RN, BSN, MS, CCM
Care Manager Dartmouth-Hitchcock
honesty
my passion is
William Brewster, MD
Harvard Pilgrim
Associate Medical
Director
Medical Center

4. So what if we partnered with health care
leaders to help get costs down and get
satisfaction up. That’s ElevateHealth!
C
reated through a unique partnership of three local non-profits—
ElevateHealth vital signs
Dartmouth-Hitchcock, Elliot Health System and Harvard Pilgrim Health Care—
Description:
ElevateHealth is all about improving quality, lowering cost and creating a
A suite of high-performance
defined network health plans
designed to raise the quality
bar and lower costs in New
Hampshire.
better patient experience for the people of New Hampshire.
As RNs at Dartmouth-Hitchcock Medical Center and Elliot Hospital, respectively, Mimi Emerson and Julie Boyer have become dynamic forces in their role
as care managers for ElevateHealthSM members. They wear many hats on
members’ behalf: health advocate and educator, as well as liaison to a close-
Introduced:
knit care delivery team, social services support and community resources
September of 2013 by founders
Dartmouth-Hitchcock, Elliot
Health System and Harvard
Pilgrim; built on sharply
aligned fiscal and health
outcome goals.
.
“We’re all working very closely together for the patient’s sake, and an
important part of my role is to help ensure all providers – and Harvard Pilgrim
– stay on the same page,” says Emerson. “As part of that, I help ‘connect the
dots’ so the care team has the right information at the right time. And the
same goes for patients – I have to ensure they understand the support system
and have access to the right resources, especially when they’re discharged.
Differentiator:
That could include local and nationally based extended support, including
Brings care coordination back
to local, close-knit health care
teams.
special services, even arranging transportation.
“One of the most valuable aspects of ElevateHealth is in the sharing of claims
and medical data between Harvard Pilgrim and the various providers, adds
Network:
Emerson. “That brings the picture all together, which helps us deliver better
More than 400 PCPs,
2,600 specialists and five
leading hospitals specially
selected for their effectiveness
and quality performance.
care to each patient, while reducing the potential for duplication of tests and
services. And, it helps improve overall population health, because it enables
us to identify trends and find opportunities for improvement.”
“No more silos – that’s one of the key advantages of ElevateHealth,” says
Boyer. “The health plan and providers are really working in synch – something
that doesn’t often happen. “And within that partnership, Harvard Pilgrim’s role
is much more than that of a bill payer.
“The tight collaboration and communication within the care delivery team are
vital to better care,” notes Boyer, “and so is my role as a proactive resource for
Julie Boyer, RN
overcoming
my passion is
Care Manager
Elliot Health Systems
healthcare barriers for members
patients. That includes reaching out to them upon discharge to address any
issues before they turn into real barriers. Just knowing that we’re available and
accessible to help navigate a complicated system can bring great peace of
mind at a difficult time.
“ElevateHealth is truly a different approach that can make a real impact,”
says William Brewster, M.D., Harvard Pilgrim associate medical director,
“particularly around the role of provider partner nurses playing pivotal roles as
patient advocates, clinical liaisons with primary care providers and specialists,
as well as promoters of health and wellness among the patient population.
The level of honest, open sharing that we have experienced has resulted in
a transformative relationship between an insurer and providers.”
Payment model:
A sharp departure from the
costly fee-for-service approach
rewarding volume, ElevateHealth rewards providers
based on patient outcomes
and efficiency of care.

5. innovation
my passion is
Cynthia Rosenberg, M.D
Harvard Pilgrim Senior
Medical Director
David Harlan, M.D
engagement
my passion is
UMass Medical Center
Diabetes Research
with my patients lives

6. So what happens when a health insurer
supports provider innovation? A better
patient experience and improved value.
my passion
is keeping things
simple
Christina Lindsey
Harvard Pilgrim member
and Layla
O
ver the last century, the medical system mastered how to fix a broken
bone, take out an appendix and treat pneumonia. But it hasn’t been as
effective in treating chronic conditions like diabetes.
In fact, the costs of diabetes are on the rise. The American Diabetes
Association estimates that the total costs of diagnosed diabetes rose to
$245 billion in 2012—a 41% increase since 2007.
Dr. David Harlan, Chief of Diabetes and Co-director of the UMass Memorial
Diabetes Center of Excellence, is working with help from Harvard Pilgrim to
change that.
Introduced by Dr. Harlan and his colleagues, MyCareTeam Clinical is a
groundbreaking online diabetes management system that lets a patient
download blood sugar readings from most meters using a secure home
Internet connection. The information then is uploaded to the patient’s
electronic medical record and the physician gets an alert. Patients can also
use the system to send doctors secure messages.
“It’s a better way to communicate, much more efficient,” says Dr. Harlan.
“It saves patients’ trips to the office and is a better way to feel connected
all the time. The meat of the discussion with my patients is always what
they’re doing to control their blood glucose.”
Harvard Pilgrim member Christina Lindsey, 29, says the system is easy to use,
and her blood glucose levels have improved by one percentage point since
she started uploading her meter over a year ago.
“Instead of wondering and waiting for an appointment, now I can see how
I’m doing right when I upload my meter,” says Lindsey, who has been living
with diabetes for 19 years. “I can see graphs, trends and patterns, and because
a copy is sent to the clinic, they can tell me if I need to adjust anything.”
But patient care is just part of the equation. Providers now are paid on a
fee-for-service basis—not an ideal payment system for patients with chronic
conditions, says Cynthia Rosenberg, M.D., Harvard Pilgrim’s Senior Medical
Director. Through a Harvard Pilgrim Quality Grant, UMass and Harvard Pilgrim
began a two-year program to develop a better way to pay for the total care of
these diabetic patients that has better value for all.
“We’re excited to be working with an innovator like Dr. Harlan,” says Dr.
Rosenberg. “This will result in more collaboration among PCPs and specialists so they can provide the best possible care for patients. And, this current
project builds on work that we have done together in the past related to both
diabetes and care coordination.”
The partnership will help reduce the need for face-to-face visits—and trips
to the emergency room—minimize the need for paperwork, and ultimately
improve patient satisfaction and outcomes.
“If we are engaging the patients and their providers, of course they’ll do
better,” says Dr. Harlan. “It’s just that nobody has ever figured out a way to do
that that doesn’t add a ton of work to an already overburdened health care
system. I think we’ve got it now.”
Through its Quality Grants
Program, Harvard Pilgrim
has funded more than 190
initiatives in the last 13 years
with innovative providers
across the region.
This program also identifies
best practices that other Harvard
Pilgrim network clinicians can
be replicate, and is one of many
ways Harvard Pilgrim supports
providers in transforming care
delivery. Our innovative care
delivery models also explore
and encourage care for members
that improves outcomes, reduces
costs and enhances their care
experience.
The first successful care delivery
models for primary care and
specialty medical homes have
been joined by bundled
payment models with select
providers for coronary artery
bypass graft in Maine,
colonoscopy in New Hampshire
and tonsillectomy in
Massachusetts.
Through bundled payment,
a group of providers is paid
one amount for an entire episode
of care, rather than fee-forservice, encouraging providers
to work more efficiently together,
communicate more effectively,
and focus more on outcomes.

7. empowering
my passion is
women
Diane Skog
Deqa Dhalac
leading
my passion is
my community

8. equity
my passion is
Mitzi Johnson M.D.
Harvard Pilgrim
Culture Insight
So what if we helped local leaders make
health care more equitable in Maine? Yes!
E
nsuring that everyone has access to high-quality, culturally appropriate
health care is a major issue and opportunity for our society. The Harvard Pilgrim
Health Care Foundation’s Culture InSight program is helping community
leaders in Maine make health care more equitable for two of the state’s
vulnerable populations. Culture InSight provides cultural competency
training, consulting and organizational development services to health and
human services professionals and their organizations to create sustainable
changes in health care delivery.
Culture InSight worked with the Daniel Hanley Center for Health Leadership
to train graduates of the center’s health leadership development program as
health disparity ambassadors. The ambassadors were asked to launch projects
to identify and address health disparities in their communities.
In Portland, Hanley alumni Deqa Dhalac and Diane Skog teamed up to
coordinate weekly educational meetings for mothers among the city’s Somali
refugee and immigrant population.
“At work I was seeing a lot of people having a really hard time with the
American health care system,” says Dhalac, a native of Somalia. “They cannot
access anything because of the language barrier and the culture barriers.”
Each week, Dhalac and Skog brought in local health professionals to teach the
mothers in their native language about important child health topics such as
oral health, healthy eating, immunizations and literacy. The meetings gave the
Somali women a place to socialize and make connections. Some have even
become aspiring child care providers based on what they learned.
“The Culture InSight training was amazing,” says Skog. “One of the most
powerful things I heard was: ‘You know what you know and what you’re born
into.’ It’s something very simple that helped me reframe the way I look at
things.”
As the ambassadors got their projects under way, Dr. Mitzi Johnson and her
team from Culture InSight gave them feedback on and support for their work.
“These are people whose passion is not just verbal,” Johnson says of the health
ambassadors. “They are putting what I would call sweat equity into moving the
dial forward, even in a small way.”
Farther up the Maine coast, Eastport Health Care CEO Holly GartmayerDeYoung sought to engage the community in a conversation about improving
care for Washington County’s mentally ill.
For patients and their loved ones, a mental illness diagnosis often comes with a
high degree of shame and judgment. For health care practitioners, particularly
Since 2008, Culture InSight
has trained more than 3,000
health and social services
practitioners, representing
nearly 70 organizations.

9. my passion
listening
is compassionate
Holly Gartmayer-DeYoung
emergency room and primary care providers, there’s often a sense of
helplessness in being able to fully respond to these patients and move them
toward better living and better health.
Using a community circle model based in mindful, intentional listening,
“ oo often people think
T
Gartmayer-DeYoung initially convened a group of primary care and behavioral
cultural competency is only
health providers to start addressing the challenges. The circle grew to include
for people of color or new
patient advocates and representatives from local hospitals, law enforcement
immigrants to the U.S..
and clergy. Patients themselves and Maine legislators have joined as well.
In reality there are all kinds of
“It’s all in the spirit of listening and then lending a voice to contribute to a
disparities in many
culture shift,” says Gartmayer-DeYoung. “That’s really what’s happening.”
communities.The disparities
As for her thoughts on Harvard Pilgrim’s support for reducing health
we see in rural Maine
disparities, Gartmayer-DeYoung says that simple thankfulness doesn’t
differ from those in an
begin to cover it.
urban inner-city community,
but they may be equally lethal
“I’ve never worked with an organization that was so incredibly visionary in
in their impact.”
this regard,” she notes.“‘Gratitude’ is not an adequate word to describe
Mitzi Johnson, M.D.
Culture InSight
the personal feeling I have for the commitment Harvard Pilgrim has and
consistently demonstrates as it relates to ensuring a conversation about
health equities.”
The admiration is very much mutual, according to Johnson.“This group of
individuals has been impressive to me in their commitment to addressing
these issues in whatever way makes sense for the population they’re working
with,” she says.“I’m so proud of them, I have to tell you.”
In addition to the Hanley Center’s Health Disparities Ambassador Program,
Culture InSight is supporting four other place-based projects to reduce health
disparities through its Partnering for Healthy Communities program:
• ddressing Health Disparities through a Multi-Stakeholder Collaboration
A
New Hampshire Health Equity Partnership
• nfusing Mass in Motion with Health Equity
I
Mass in Motion
• mproving Pregnancy Care and Early Childhood Visit Rates in the Latina
I
Community in Lawrence, Mass.
Neighborhood Health Plan
• atino and Brazilian Disparities Project: Organizational Cultural Competence
L
Advocates, Inc., South Middlesex
Opportunity council and Wayside Youth and Family Support Network
CEO, Eastport Healthcare

10. So what if a nationally recognized health
system had a great idea to improve employee
health, increase health system volume and
better control costs?
L
ahey Health did! And they chose Harvard Pilgrim as their sole partner to make it
happen. Together, they built a tiered network product that encouraged employee colleagues
to choose their medical care within the Lahey system and developed a leading edge,
multi-faceted wellness program that helped make Lahey Health a healthier organization.
“We trusted only Harvard Pilgrim to help us create the kind of tiered network plan we wanted,”
says Sharon DiSalvo, director, compensation benefits for Lahey Health. “Not just in terms of
the plan design, but the high-level of customer service and support that is needed for success.
The way Harvard Pilgrim helped us roll out the plans was perfect.”
DiSalvo says solid communications assured Lahey colleagues they would receive excellent
care with the utmost of privacy and confidentiality.”Our benefit plans are doing exactly what
we need them to do. People come here to get medical care. Outcomes are outstanding, and
that’s what we want,” she says.
The tiered network plans are just part of a comprehensive strategy that included making
progress with an outcomes-based wellness program, another priority for the organization
results
my passion is
Tracey Esperanza, Lahey Health, Senior Benefits Analyst
and President and CEO Dr. Howard Grant. “We are making Lahey Health a healthier hospital
system so that we’re solid role models for better health in our community,” says DiSalvo.
According to Jamesie Gifford, manager of health education at Harvard Pilgrim, it is inspiring
to see Lahey Health’s Live Better program commitment to include its entire community. “They
encourage spouses of colleagues and even volunteers to participate,” she says. And the scale
of the effort is also very impressive.” The program included more than 60 annual biometric
screenings each fall as well as monthly wellness seminars on topics related to improving
BMI, blood pressure, stress levels or fitness routines. Another unique program element is a
dedicated Lahey Health nurse consultant, who connects health and wellness with medical care.
“She may check in with colleagues after coming home from the hospital, help them identify
the appropriate Lahey Health clinician or guide them to a wellness coach,” says Gifford.
Harvard Pilgrim is also rolling out an advanced online wellness system in 2013 to further power
the wellness effort. “This technology is a welcome addition to our Live Better program and
opens the door for many new opportunities, including online challenges that can bridge
colleagues who work at different hospital locations, “says Tracy Esperanza, Lahey Health
senior benefits analyst. “We’re looking forward to how these new tools will add to the early
success of our program”
Overall the effort is on track and delivering results, and the partnership is a big factor in that
success. “Constant collaboration, quality work and the drive to improve are critical in the
changing world of health care and wellness,” says Esperanza. “What impresses me most, is
how the Harvard Pilgrim team works truly for the good of Lahey Health. They always bring the
right people to the table to get things done no matter who I’m working with, or the challenges
at hand. I trust that the quality of work will exceed my expectations every time.”
nutrition
my passion is
Sharon DiSalvo, Lahey Health, Director of Compensation Benefits

11. I initially participated in the
Lahey Health Live Better
program solely to save money
on my insurance. More than
a year later, receiving the
financial incentive was the
least of the benefits. The Live
Better program has truly
changed my family’s life for
the better.
Attending the screenings
and seeing the reality of my
numbers was overwhelming,
especially my actual BMI and
off-the-chart hypertension
numbers. I knew I had to do
something, for my baby girl.
Since my husband was in even
a more dire health situation,
he also wanted to take action.
With the support of Lahey
Health’s medical weight loss
program, plus ongoing tips
from my Harvard Pilgrim
health coach, together we
have lost nearly 200 pounds
through diet and exercise.
We still have a ways to gombut today, my blood pressure
is within normal range and
I’ve dropped 10 BMI points.
My husband can now keep
up with our active toddler
and take on bigger home
improvements projects.
We’ve successfully changed our
eating habits, surviving the
holidays and our daughter’s
first birthday. Best of all, we
are passing along good habits
to her. She loves her fruits a
nd vegetables, yogurt and
protein—even flax seed
crackers.
teaching
my passion is
Amy Zaganjori
Lahey Health Employee
Grace to eat healthy
action
my passion is
Jamesie Gifford
Harvard Pilgrim
Health Education
Manager

12. my passion is
helping families
make healthy decisions
Jennifer Bram, MD
UMass Medical Center
my passion is
reversing
the curse
of childhood obesity
Mike Devlin
Harvard Pilgrim Health
Care Foundation
building
relationships
my passion is
with communities
Emily Walters
Let’s Go!

13. So what if we could take a great program
in Maine to prevent childhood obesity and
make it work in other states? Run with it!
T
hat’s what pediatrician Dr. Martha Waite did when she was given the
opportunity to help bring Maine’s Let’s Go Healthcare program to eight
Reliant Medical Group practices in central Massachusetts that serve pediatric
patients.
Introduced in Maine several years ago, Let’s Go Healthcare partners with
primary care physicians to provide educational outreach, supporting
materials and training on healthy eating and physical activity to prevent
childhood obesity.
It’s been highly successful and effective because it uses simple tools that
providers can use to start a conversation with patients and families about
Let’s Go! is a nationally
recognized childhood obesity
prevention program designed to
increase healthy eating and
active living in children from
birth to 18. Let’s Go! works
in six settings (schools, early
childhood, after school, health
care, workplace and community)
to reach children and families
where they live, learn, work
and play.
healthy behavior and weight. Funded by the Harvard Pilgrim Health Care
Foundation’s Growing Up Healthy initiative and implemented in partnership
with MaineHealth, the program was recently expanded to other states.
“We now have 17 champions in three states,” said Emily Walters, program
manager, Community Health Improvement, MaineHealth. “These are
physicians who work with their peers across the region, and are committed
to spreading the Let’s Go healthy lifestyle message.”
Dr. Waite is now a physician champion for the program. She works directly
More than 152 provider
practices across Maine, New
Hampshire and Massachusetts
are now participating in Lets
Go! Healthcare. Participants
must meet three basic criteria
in order to be recognized as a
Let’s Go! Site of Distinction:
with her counterparts in Maine as well as her peers in central Massachusetts.
With support from the Harvard Pilgrim Foundation, she leads monthly
meetings with staff from Reliant Medical Group to ensure the program is
successful. “I use it in my own practice,” said Dr. Waite. “For example, the
health questionnaire is a simple tool that helps me identify areas to focus on.
• isplay a Let’s Go! poster
D
in the waiting room and all
exam rooms where pediatric
patients are seen
If I see that someone is eating zero fruits and vegetables a day, I can say
‘How about we start with one or two a day?’ That’s something concrete they
can work on and not get discouraged.”
moving
my passion is
getting kids
Martha Waite, M.D.
Reliant Medical Group
• ll providers determine BMI
A
for patients age two years and
older
Pediatricians at UMass are also using the program. Dr. Jennifer Bram,
pediatrician and Let’s Go champion is delighted at the simplicity of the
program. “The beauty of the 5210 message is that it is easy to remember,”
she says. “People are paying more attention, especially health care providers
• providers use the 5-2-1-0
All
Healthy Habits Questionnaire
at well child visits
who are looking for more structure on how to help prevent childhood obesity.
“The investment that Harvard Pilgrim has made shows a true commitment to
patients, says Dr. Bram. “We need community partners who share our same
values, and we have found that in Harvard Pilgrim.”
Growing Up Healthy is the Harvard Pilgrim Health Care Foundation’s leadership and funding initiative whose goal is to reduce childhood obesity among
children aged 6-12 years in Massachusetts, New Hampshire and Maine.
The 5-2-1-0 message
Strive for these health habits
for children every day everyday:
5 fruits and veggies
2 ours or less of recreational
h
screen time*
1 our or more of physical
h
activity
0 ugary drinks, more water
s
and low-fat milk

14. When patient Starr Hill
and Harvard Pilgrim
Onocology Nurse Donna
Cady met for the first time
their relationship was clear.
sharing connecting
my passion is
my passion is
Starr Hill
Donna Cady
Patient
Harvard Pilgrim
Onocology Nurse

15. So what would you do if you really needed
someone to have your back, and they did?
Pay it forward.
S
tarr Hill has always taken care of herself, eating right and exercising.
So when the 48-year-old mother of two experienced recurring stomach pain,
it didn’t seem like a big deal. But it was. A visit to her doctor revealed colorectal
cancer that had spread, and the road ahead for her was overwhelming.
“We all know that some day we are going to die, and that thought is usually far
away, but all of a sudden it was right in my face,” she says.
Starr and her oncologist decided to attack the disease with chemotherapy –
delivered in the hospital every 14 days for about six months. As she was preparing mentally and physically to begin, she received a call from Donna Cady, R.N.,
a Harvard Pilgrim oncology nurse. Donna was alerted by a claims analysis that
Starr may benefit from Harvard Pilgrim’s oncology care management program.
“When I first started talking to Starr she didn’t want to know too much,” says
Donna. “I respect that. What you need to know is whatever you feel you need
to know. Because she was starting treatment we focused on the symptoms she
was experiencing, and on finding strategies to manage those side effects.”
“Donna helped me a lot during chemotherapy” says Starr. “She is a great listener and her sound advice has helped me remember that I am doing ok. I can turn
to her with questions and she gets answers for me.” Donna and Starr also talked
about how overwhelming it can be to talk to others about an illness. “I was
getting many text messages and calls. I was so grateful that people cared so
much but I was also exhausted trying to keep up,” says Starr.
At a friend’s suggestion, Starr started posting online journal entries at CaringBridge, a Web site where people with health challenges can post updates for
friends and family. “Writing down what she was doing also became a form of
therapy for Starr,” says Donna. “And more and more people started sharing
with her and supporting her. She learned a lot about herself and it helped her.”
Starr also began sharing on Facebook, and began focusing on raising colorectal
cancer awareness – all while she was undergoing her own treatments.
In March, for a national dress in blue day to raise awareness for colorectal cancer,
several of Starr’s friends decorated a local bridal shop window in royal blue in
her honor and gave her a blue dress to wear. “I kept saying to everyone, ‘dress
in blue on this day and share your pictures with me,’” she says. “My Facebook
page was a sea of blue. It was amazing.”
Starr also started preparing care packages for hospital patients about to begin
chemotherapy. “She really has developed and grown a lot in the last year,” says
Donna. “Her work to raise awareness and help others has helped her. She has
become more active and proactive in her care, and now wants to know more
about her condition.”
Although Starr’s treatment continues, the positive energy from the community
and from Donna has played a huge part in how she is feeling – which is better.
“It’s not in my face anymore,” she says. “And when Donna is talking to me, it’s for
me and all about me, which is a great thing when you are going through this.”
Navigating your health care
can be overwhelming. Harvard
Pilgrim nurse care managers
help members through their
health challenges by:
• elping follow their doctor’s
H
treatment plan
• ffering tips and resources
O
to help manage their
condition, including
awareness of possible
symptoms and side effects
• roviding a listening ear
P
for physical and emotional
support
• elping communicate better
H
with the doctor and other
members of the care team
• roviding information on
P
available community
resources
Harvard Pilgrim care managers
assist more than 70,000
members each year with a
range of medical conditions,
including cancer, diabetes,
asthma, heart failure, coronary
artery disease and renal disease.

16. engaging
people
my passion is
differently
Because that’s how you get great ideas.
Eric Schultz
Harvard Pilgrim
President and CEO
W
e believe great ideas can come from anyone, anywhere, anytime – that’s why we take
special care to listen.
With more than 10 constituent advisory councils, including a unique online member panel called
Harvard Pilgrim Listens, we constantly engage to seek out new ideas. But taking great ideas
and making them a reality is hard to do, and it always works best when you have passionate,
dedicated partners to focus on them together.
In addition to the stories we’ve already featured in this report, I also would like to share the
following partnerships and great ideas happening right here within Harvard Pilgrim’s own walls.
Thanks for your support as we improve the value and quality of health care for the communities
we serve – from Connecticut to Maine to Massachusetts to New Hampshire and beyond.
Eric H. Schultz
CEO@harvardpilgrim.org
Eastern Harmony - the best of eastern
and western medicine
Harvard Pilgrim also announced the launch of Count
Us In Community Partners in 2013: a year-long
partnership with the Asian American Civic Association
In 2013, Harvard Pilgrim unveiled its Eastern Harmony
and Saheli Boston – nonprofit organizations working
program that combines the traditions of western
with the Chinese and Asian Indian communities
medicine with those of China and India – like
respectively.
acupuncture, ayurvedic practices, herbal medicine
and mindfulness.
The Asian American Civic Association has served and
advocated for the needs of immigrants and other
Eastern Harmony is now a plan that is available to
economically disadvantaged people since 1967. Saheli
employers who want to offer greater access to
Boston is the only nonprofit organization specifically
alternative health care approaches. While Eastern
providing support services, training programs and
Harmony is benefiting Chinese and Asian Indian
recovery resources to South Asian American women
employers who told us they have long been looking
affected by domestic violence and abuse.
for this kind of option, it also has expanded choice
for our members at large.

17. engaging
people
my passion is
differently
Eric Schultz
Harvard Pilgrim
President and CEO
Because that’s how you get great ideas.
W
e believe great ideas can come from anyone, anywhere, anytime – that’s why we take
special care to listen.
With more than 10 constituent advisory councils, including a unique online member panel called
Harvard Pilgrim Listens, we constantly engage to seek out new ideas. But taking great ideas
and making them a reality is hard to do, and it always works best when you have passionate,
dedicated partners to focus on them together.
In addition to the stories we’ve already featured in this report, I also would like to share the
following partnerships and great ideas happening right here within Harvard Pilgrim’s own walls.
Thanks for your support as we improve the value and quality of health care for the communities
we serve – from Connecticut to Maine to Massachusetts to New Hampshire and beyond.
Eric H. Schultz
CEO@harvardpilgrim.org
Eastern Harmony - the best of eastern
and western medicine
Harvard Pilgrim also announced the launch of Count
Us In Community Partners in 2013: a year-long
In 2013, Harvard Pilgrim unveiled its Eastern Harmony
partnership with the Asian American Civic Association
program that combines the traditions of western
and Saheli Boston – nonprofit organizations working
medicine with those of China and India – like
with the Chinese and Asian Indian communities
acupuncture, ayurvedic practices, herbal medicine
respectively.
and mindfulness.
The Asian American Civic Association has served and
Eastern Harmony is now a plan that is available to
advocated for the needs of immigrants and other
employers who want to offer greater access to
economically disadvantaged people since 1967. Saheli
alternative health care approaches. While Eastern
Boston is the only nonprofit organization specifically
Harmony is benefiting Chinese and Asian Indian
providing support services, training programs and
employers who told us they have long been looking
recovery resources to South Asian American women
for this kind of option, it also has expanded choice
affected by domestic violence and abuse.
for our members at large.

18. Health Plans, Inc., is New England’s
leading administrator of self-funded
benefit plans and a Harvard Pilgrim
company
The program is providing sponsorship and grant
In 2013, the Institute was awarded a $9 million grant
support to build each organization’s capacity to
from the Patient-Centered Outcomes Research
enhance its services. In addition, each agency is
Institute to lead a consortium to serve as the coordinat-
receiving volunteer support from Harvard Pilgrim
ing center for a new national data network. The network
employees, promotional assistance and an opportunity
will enhance the nation’s ability to conduct patient-
for participation in mentorship programs with Harvard
centered comparative effectiveness research and
In 2005, Harvard Pilgrim acquired Health Plans, Inc.,
Pilgrim’s senior leaders. The new partnership’s purpose
provide patients and providers with better information
a large regional-based Third Party Administrator (TPA).
is to help local nonprofits maximize their services and
to guide their decisions.
Who we are
With over 30 years of experience in the TPA and self-
engage Harvard Pilgrim more directly with the region’s
diverse communities.
insurance industry, Health Plans serves more than
The Institute also currently serves as the coordinating
165,000 members through a diverse set of employer
center for the FDA Mini-Sentinel program, monitoring
markets including hospitals, manufacturing firms, labor
These initiatives are part of Harvard Pilgrim’s newly
the safety of FDA-regulated medical products through
unions, municipalities, media outlets, and retail food
established Center for Inclusion Initiatives. Led by Vice
a network of electronic health care databases.
chains, among others.
President and Chief Inclusion Officer Karen Young,
Research conducted by Institute staff is shared with the
After the acquisition of Health Plans, Harvard Pilgrim
commitment to inclusion at the forefront of everything
public, patients, clinicians, government agencies, policy
leveraged the flexibility and affordability of a TPA-style
Harvard Pilgrim does. We define inclusion as valuing
makers and other health care leaders, and has been
administration along with the power of Harvard Pilgrim’s
difference and creating value through difference each
featured in leading peer-reviewed publications as well
extensive provider network and widely recognized
day – with one another, with our customers and in the
as news outlets throughout the world. Here are a few
commitment to service and quality.
community.
examples of some the Institute’s recent studies showing
that:
Under the center’s umbrella, Harvard Pilgrim established
and is uniquely positioned to offer attractive, innovative
• sing anti-microbial soap and ointment for all
U
product designs to employers seeking to provide an
intensive care patients significantly cut bloodstream
affordable yet comprehensive benefits package to their
workforce development, supplier and vendor contract-
infection, suggesting a major change in health care
employees. Health Plans also offers powerful, custom-
ing, health care equity, community engagement and
practice that could save lives.
ized plan designs and state-of-the art reporting systems.
enterprise leadership. Harvard Pilgrim has surrounded
determination to get results.
The Harvard Pilgrim Health Care
Institute - putting science to work for
the communities we serve
Health Plans’ membership revenue and profit has more
• nterventions both before and soon after birth may
I
be especially effective in preventing obesity.
than doubled since the company was acquired by
Harvard Pilgrim. Much of the impressive growth can be
attributed to Health Plans’ recognition as the premier
• ne quarter of consumers underestimate fast food
O
meals by 500 or more calories, indicating that menu
hospital benefit administrator in New England. Case in
point: In 2005 Health Plans served four hospital clients.
labeling combined with educational outreach may
help consumers understand calories better and make
The Harvard Pilgrim Health Care Institute’s Department
Today, Health Plans acts as the third party administrator
healthier food choices.
for more than twenty hospitals throughout the region.
of Population Medicine is a unique collaboration
between Harvard Pilgrim and Harvard Medical School
Our passion is to make health care work
better for the people and communities we
serve. We collaborate with members,
doctors, employers and brokers to offer
Health Plans is constantly striving to broaden its
• hile breast magnetic resonance imaging use
W
offerings. Most recently, the company managed the
that focuses on improving health care delivery and
expanded rapidly in the first decade of availability,
acquisition of MedWatch, a Florida-based medical
population health through innovative research and
the patients who had the most identifiable need for
management company presenting care management
teaching.
the test, especially those at very high risk for breast
services to self-insured employers and third party
cancer, were not necessarily the ones receiving it.
administrators nationwide. MedWatch, a URAC certified
The Institute was created in 1993 and is the only
Medical Management company offers a full spectrum
appointing medical school department in the United
Virtually all of the Institute’s $39 million annual budget
of care management programs, including case
States based in a health plan. Led by Richard Platt, MD,
is externally funded, primarily by the Food and Drug
management, disease management and utilization
MS, the Institute’s staff includes leading physicians,
Administration, the National Institutes of Health, the
review.
researchers, clinicians and public health professionals.
Patient Centered Outcomes Research Institute, the
Centers for Disease Control and Prevention, and the
Agency for Healthcare Research and Quality.
Given our nation’s focus on improving health care
quality and reducing health care costs, the Institute’s
collaborative work with health plan members, patients,
providers, leaders and government agencies is more
relevant and important than ever before.
benefit solutions, delivered with exceptional
service, all with the goal of improving value
and quality across the health care system.
Today, Health Plans is the leading TPA in New England
strategy. The tracks include marketplace connection,
these tracks with robust thinking, staff resources and a
nation’s leading not-for-profit health plans.
innovative, customized health and
the center represents a company-wide, comprehensive
six tracks intended to deliver on its inclusion business
Harvard Pilgrim Health Care is one of the
Visit us at www.harvardpilgrim.org/annual
for information about our leadership and
more details of what we’ve been up to.

19. 2013 Financials Harvard Pilgrim Health Care, Inc. and Affiliates
Harvard Pilgrim Health Care Mission
Combined Statutory Statement of Revenue and Expenses
For the years ended December 31, 2013 and 2012 ($ in thousands)
Revenue - Premium Income
2013
$2,632,821
To improve the quality and value of health care for the people and the communities we serve
2012
$2,660,539
Operating Expenses
Medical Costs
Claim Adjustment Expenses
General Administration Expenses
Underwriting Income
2,249,193
2,278,419
80,930
82,995
301,522
293,928
2,631,645
2,655,342
1,176
5,197
Core Values
Integrity
We treat others fairly and honestly - the same way we would want to be treated.
Trust
Other Income and (Expenses)
Net Investment Income
22,889
24,638
Interest Expense
(3,737)
(4,432)
Other
(521)
(2,950)
Net Income
18,631
17,256
$19,807
$22,453
We collaborate and build trust through open, honest and respectful communication.
Innovation
We find creative, new ways to bring value to the marketplace.
Excellence
Combined Statutory Balance Sheets
We expect the best from ourselves and strive to maximize value and service for our constituents.
As of December 31, 2013 and 2012 ($ in thousands)
Assets
2013
2012
$845,222
$872,928
124,401
Inclusion
112,487
Cash And Securities
Net Premiums and Other Receivables
Net Fixed Assets
41,072
41,562
Intangible Assets
4,784
5,739
Other Assets
39,169
25,446
Total Assets
$1,054,648
We value difference and create value through difference.
$1,058,162
Community
We make a positive difference in the communities we serve.
People
Liabilities Net Worth
We succeed by building a talented workforce and caring about our employees and their families.
Liabilities
Claims Payable Accrued Medical
Incentive Pool
Accounts Payable Accrued Expenses
$220,603
$249,203
Accountability
173,195
189,450
We do what we say we will do and lead by example.
Premium Received in Advance
63,190
50,679
Other
34,659
37,061
Total Liabilities
491,647
526,393
Statutory Net Worth
563,001
531,769
$1,054,648
$1,058,162
Total Liabilities Net Worth
Another creative partnership: Editorial: Harvard Pilgrim Marketing Communications | Design: Yellow Inc. | Photography: Webb Chappell | Printing: Universal Wilde

20. Connecticut
185 Asylum Street, 2nd Floor, Hartford, CT 06103
Maine
1 Market Street, 3rd Floor, Portland, ME 04101
Massachusetts
93 Worcester Street, Wellesley, MA 02481
1600 Crown Colony Drive, Quincy, MA 02169
427 Main Street, Suite 200, Worcester, MA 01608
New Hampshire
650 Elm Street, 7th Floor, Manchester, NH 03101
Harvard Pilgrim Health Care Institute
133 Brookline Avenue, Boston, MA 02215
Health Plans, Inc. Headquarters
1500 West Park Drive, Suite 330
Westborough, MA 01581
1.888.888.4742
www.harvardpilgrim.org