H a r v a r d P i l g r i m H e a l t h C a r e 2 0 1 3 A n n u a l R e p o r t

&greatideas

inspiredpartners

a m a z i n g

t h i n g s h a p p e n

w h e n p e o p l e

w o r k t o g e t h e r&

our passion is

People ask me all the time, “How is Harvard Pilgrim 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 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. Trusted partners are honest and

do 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 impact 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 change and opportunity.

Here’s to great ideas, 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.

that workpartnerships

my passion is helping people find the

and hope to get healthycourage

Mimi Emerson, R.N., B.S.N., M.S., C.C.M.

Care Manager

Dartmouth-Hitchcock Medical Center

my passion ishonestyWilliam Brewster, M.D.

Harvard Pilgrim

Associate Medical

Director

So what if we partnered with health care leaders to help get costs down and get satisfaction up? That’s ElevateHealth!

Created through a unique partnership of three local nonprofits —

Dartmouth-Hitchcock, Elliot Health System and Harvard Pilgrim Health Care

— ElevateHealthSM is all about improving quality, lowering costs and creating

a 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 roles as care managers for ElevateHealth members. They wear

many hats on members’ behalf: health advocate and educator, as well as

liaison to a close-knit care delivery team, social services support and

community resources.

“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. That could include local and nationally based extended

support, including 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

Emerson. “That brings the picture all together, which helps us deliver better

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 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 pivotal roles care managers play as patient advocates,

clinical team liaisons and 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.”

ElevateHealth Vital Signs

Description:

Health plans with a network

of high-performing providers,

designed to raise the quality

bar and lower costs in

New Hampshire.

Introduced:

September of 2013 by

founders Dartmouth-Hitchcock,

Elliot Health System and

Harvard Pilgrim; built on keenly

aligned health outcome and

fiscal goals.

Differentiator:

Brings care coordination

back to local, close-knit health

care teams, which is best for

the patient.

Network:

More than 400 PCPs,

2,600 specialists and five

leading hospitals specially

selected for their effectiveness

and quality performance.

Payment model:

A deliberate departure from

the costly fee-for-service

approach rewarding volume,

ElevateHealth rewards

providers based on patient

outcomes and efficiency

of care. my passion is

health care barriers for membersovercoming

Julie Boyer, R.N.

Care Manager

Elliot Health Systems

my passion isengagementDavid M. Harlan, M.D.

UMass Memorial Medical Center

Diabetes Center of Excellence

with my patients’ lives

my passion isinnovationCynthia Rosenberg, M.D.

Harvard Pilgrim

Senior Medical Director

So what happens when a health insurer supports provider innovation? A better patient experience and improved value.

Over 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 the Department of Medicine’s Diabetes Division 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 their doctor a secure message.

“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 Hgb A1c has significantly improved 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 readings,” says Lindsey, who has been living with diabetes for 19 years and is eight-months pregnant. “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. “Historically, providers 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 senior medical director. Through a Harvard Pilgrim Quality Grant, UMass Memorial and Harvard Pilgrim are developing an innovative 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 effective collaboration among PCPs and specialists so that 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 online monitoring of blood sugar readings will help to 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 been challenging to figure out a way to do that without adding a ton of work to an already overburdened health care system. I’m convinced that we are on the right track.”

Through its Quality Grants Program, Harvard Pilgrim has funded more than 208 initiatives in the last 14 years with innovative providers across the region.

This program also identifies best practices that other Harvard Pilgrim network clinicians can replicate and is one of the 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 in Maine, Massachusetts and New Hampshire.

Through a bundled payment methodology, a group of providers is paid one amount for an entire episode of care, rather than fee-for-service, encouraging providers to work together more efficiently, communicate more effectively, and focus more on outcomes and the overall patient experience.

my passion is keeping thingssimpleChristina Lindsey

Harvard Pilgrim member

and Layla

my passion isempowering women

Diane Skog

Director of Marketing

and Development

Saint Andre Home

my passion isleading my community

Deqa Dhalac

Human Services Counselor

Survivor of Torture Program

City of Portland

So what if we helped local leaders make health care more equitable in Maine? Yes!

Ensuring 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 providers,

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 that will 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 also 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,” Dr. Johnson says of the

health ambassadors. “They are putting what I would call sweat equity into

moving the health equity dial forward, even in small ways.”

Farther up the Maine coast, Eastport Health Care CEO Holly Gartmayer-

DeYoung 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 may often come

with a high degree of shame and judgment. For health care practitioners,

For more than 20 years,

Culture InSight has been a

national leader in the field

of cultural competency for

health and human services

professionals and their

organizations. To help

organizations achieve cultural

competency, Culture InSight

offers a range of services,

including organizational

assessments, community

mapping, interdisciplinary

team building, program

design, data analysis and

leadership development.

my passion isequity

Mitzi Johnson, M.D.

Cross Cultural Health

Care Specialist

Culture InSight

women

my passion is compassionate

listeningHolly Gartmayer-DeYoung

CEO, Eastport Health Care

particularly 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,

Gartmayer-DeYoung initially convened a group of primary care and behavioral

health providers to start addressing the challenges. The circle grew to include

patient advocates and representatives from local hospitals, law enforcement

and clergy. Patients themselves and Maine legislators have joined as well.

“It’s all in the spirit of listening and then lending a voice to contribute to a

culture shift,” says Gartmayer-DeYoung. “That’s really what’s happening.”

As for her thoughts on Harvard Pilgrim’s support for reducing health

disparities, Gartmayer-DeYoung says that simple thankfulness doesn’t

begin to cover it.

“I’ve never worked with an organization that was so incredibly visionary in

this regard,” she notes.“‘Gratitude’ is not an adequate word to describe

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 Dr. 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:

• Addressing Health Disparities through a Multi-Stakeholder Collaboration

New Hampshire Health & Equity Partnership

• Infusing Mass in Motion with Health Equity

Mass in Motion

• Improving Pregnancy Care and Early Childhood Visit Rates in the Latina

Community in Lawrence, Massachusetts

Neighborhood Health Plan

• Latino and Brazilian Disparities Project: Organizational Cultural Competence

Advocates, Inc., South Middlesex Opportunity Council and Wayside Youth

and Family Support Network

“ Too often people think

cultural competency is only

for people of color or new

immigrants to the U.S.

In reality there are all kinds

of disparities in many

communities.The disparities

we see in rural Maine differ

from those in an urban

inner-city community, but

they may be equally lethal

in their impact.”

Mitzi Johnson, M.D. Culture InSight

my passion is

my passion is

nutrition

resultsTracy Esperanza, Senior Benefits Analyst, Lahey Health

Sharon DiSalvo, Director of Compensation & Benefits, Lahey Health

So what if a nationally recognized health system had a great idea to improve their employee health, increase health system volume and better control plan costs?

Lahey Health did! And they chose Harvard Pilgrim as their sole health plan partner to

make it happen. Together, we built a tiered network product that encouraged Lahey Health

employee colleagues to choose their medical care within the Lahey Health system and

developed a leading edge, multi-faceted wellness program that is working to make

Lahey Health a healthier organization.

“We trusted 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 that solid communications assured Lahey Health colleagues they would receive

excellent care with the utmost of privacy and confidentiality. ”Our benefit plans are designed

to support our employees and are aligned to our corporate strategies. A large number of our

members are coming here to receive medical care.”

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

and its President and CEO Dr. Howard Grant. “Our efforts are to help make Lahey Health

a healthier hospital system so that we’re 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 rolled 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 success of our program.”

Our efforts are 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.”

my passion isactionJamesie Gifford

Harvard Pilgrim

Health Education

Manager

my passion is

Amy Zaganjori

Lahey Health

Employee

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 go,

but 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 improvement

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 and vegetables, yogurt

and protein — even flax seed

crackers.

teachingGrace to eat healthy

make healthy decisions

my passion is building

my passion is

within communities

helping families

relationships

Jennifer Bram, M.D.

UMass Memorial Medical Center

Emily Walters, CHES

Let’s Go! Healthcare

MaineHealth

my passion is

of childhood obesity

reversing the curse

Mike Devlin

Harvard Pilgrim Health

Care Foundation

T

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!

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

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, Let’s Go! Healthcare, 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

with her counterparts in Maine as well as her peers in central Massachusetts.

With support from the Harvard Pilgrim Foundation, she provides monthly

updates to 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.

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

patients can work on and not get discouraged.”

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 5-2-1-0 message is that it is easy to remember,”

she says. “People are paying more attention, especially health care providers

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 leader-

ship and funding initiative whose goal is to reduce childhood obesity among

children age 6-12 years in Massachusetts, New Hampshire and Maine.

Let’s Go! is a nationally recognized childhood obesity prevention program that

reaches children and families in six settings where they live, learn, work and play.

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.

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:

• Display a Let’s Go! poster

in the waiting room and all

exam rooms where pediatric

patients are seen

• All providers determine BMI

for patients age two years

and older

• All providers use the 5-2-1-0

Healthy Habits Questionnaire

at well-child visits

The 5-2-1-0 messageStrive for these healthy habits

for children every day:

5 fruits and veggies

2 hours or less of recreational

screen time*

1 hour or more of physical

activity

0 sugary drinks, more water

and low-fat milk

* keep TV/computer out of

bedroom. No screen time

under age of two.

my passion is getting kidsmovingMartha Waite, M.D.

Reliant Medical Group

my passion isconnectingDonna Cady, R.N.

Harvard Pilgrim

Oncology Nurse

When patient Starr Hill and Harvard Pilgrim Oncology Nurse Donna Cady met for the first time, their relationship was clear.

my passion issharing Starr Hill

Harvard Pilgrim member

So what would you do if you really needed someone to have your back, and they did? Pay it forward.

Starr 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 someday 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 Caring-Bridge, 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:

• Helping follow their doctor’s treatment plan

• Offering tips and resources to help manage their condition, including awareness of possible symptoms and side effects

• Providing a listening ear for physical and emotional support

• Helping communicate better with the doctor and other members of the care team

• Providing information on available community resources

Each year Harvard Pilgrim care managers assist more than 70,000 members with a range of medical conditions, including cancer, diabetes, asthma, heart failure, coronary artery disease and renal disease.

differently Because that’s how you get great ideas.

We 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 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

Eastern Harmony — the best of eastern and western medicine

In 2013, Harvard Pilgrim unveiled its Eastern Harmony

program that combines the traditions of western

medicine with those of China and India — like

acupuncture, ayurvedic practices, herbal medicine

and mindfulness.

Eastern Harmony is now available to employers who

want to offer greater access to alternative health care

approaches. While Eastern Harmony is benefiting

Chinese and Asian Indian employers who told us they

have long been looking for this kind of option, it also

has expanded choice for our members at large.

Harvard Pilgrim also announced the launch of Count

Us In Community Partners in 2013: a year-long

partnership with the Asian American Civic Association

and Saheli Boston — nonprofit organizations working

with the Chinese and Asian Indian communities

respectively.

The Asian American Civic Association has served

and advocated for the needs of immigrants and

other economically disadvantaged people since

1967. Saheli Boston is the only nonprofit organization

specifically providing support services, training

programs and recovery resources to South Asian

American women affected by domestic violence

and abuse.

my passion isengaging people

Eric H. Schultz

President and CEO

Harvard Pilgrim

differently

Who we are

Harvard Pilgrim Health Care is one of the

nation’s leading not-for-profit health plans.

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

innovative, customized health and

benefit solutions, delivered with exceptional

service, all with the goal of improving value

and quality across the health care system.

Visit us at www.harvardpilgrim.org/annual

for information about our leadership and

more details of what we’ve been up to.

Count Us In Community Partners is providing

sponsorship and grant support to build each

organization’s capacity to enhance its services. In

addition, each agency is receiving volunteer support

from Harvard Pilgrim employees, promotional assistance

and an opportunity for participation in mentorship

programs with Harvard Pilgrim’s senior leaders. The

new partnership’s purpose is to help local nonprofits

maximize their services and engage Harvard Pilgrim

more directly with the region’s diverse communities.

These initiatives are part of Harvard Pilgrim’s newly

established Center for Inclusion Initiatives. Led by Vice

President and Chief Inclusion Officer Karen Young,

the Center represents a company-wide, comprehensive

commitment to inclusion at the forefront of everything

Harvard Pilgrim does. We define inclusion as valuing

difference and creating value through difference each

day — with one another, with our customers and in the

community.

Under the center’s umbrella, Harvard Pilgrim established

six tracks intended to deliver on its inclusion business

strategy. The tracks include marketplace connection,

workforce development, supplier and vendor contract-

ing, health care equity, community engagement and

enterprise leadership. Harvard Pilgrim has surrounded

these tracks with robust thinking, staff resources and a

determination to get results.

The Harvard Pilgrim Health Care Institute — putting science to work for the communities we serve

The Harvard Pilgrim Health Care Institute’s Department

of Population Medicine is a unique collaboration

between Harvard Pilgrim and Harvard Medical School

that focuses on improving health care delivery and

population health through innovative research and

teaching.

The Institute was created in 1993 and is the only

appointing medical school department in the United

States based in a health plan. Led by Richard Platt, M.D.,

M.S., the Institute’s staff includes leading physicians,

researchers, clinicians and public health professionals.

In 2013, the Institute was awarded a $9 million grant

from the Patient-Centered Outcomes Research

Institute to lead a consortium to serve as the

coordinating center for a new national data network.

The network will enhance the nation’s ability to

conduct patient-centered comparative effectiveness

research and provide patients and providers with

better information to guide their decisions.

The Institute also currently serves as the coordinating

center for the FDA Mini-Sentinel program, monitoring

the safety of FDA-regulated medical products through

a network of electronic health care databases.

Research conducted by Institute staff is shared with the

public, patients, clinicians, government agencies, policy

makers and other health care leaders, and has been

featured in leading peer-reviewed publications as well

as news outlets throughout the world. Here are a few

examples of some of the Institute’s recent studies

showing that:

• Using anti-microbial soap and ointment for all

intensive care patients significantly cut bloodstream

infection, suggesting a major change in health care

practice that could save lives.

• Interventions both before and soon after birth may

be especially effective in preventing obesity.

• One quarter of consumers underestimate fast food

meals by 500 or more calories, indicating that menu

labeling combined with educational outreach may

help consumers understand calories better and

make healthier food choices.

• While breast magnetic resonance imaging use

expanded rapidly in the first decade of availability,

the patients who had the most identifiable need for

the test, especially those at very high risk for breast

cancer, were not necessarily the ones receiving it.

Virtually all of the Institute’s $39 million annual budget

is externally funded, primarily by the Food and Drug

Administration, the National Institutes of Health, the

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.

Health Plans, Inc., is New England’s leading administrator of self-funded benefit plans and a Harvard Pilgrim company

In 2005, Harvard Pilgrim acquired Health Plans, Inc.,

a large regional-based third-party administrator (TPA).

With more than 30 years of experience in the TPA and

self-insurance industry, Health Plans serves more than

165,000 members through a diverse set of employer

markets including hospitals, manufacturing firms,

labor unions, municipalities, media outlets and retail

food chains, among others.

After the acquisition of Health Plans, Harvard Pilgrim

leveraged the flexibility and affordability of a TPA-style

administration, along with the power of Harvard

Pilgrim’s extensive provider network and widely

recognized commitment to service and quality.

Today, Health Plans is the leading TPA in New England

and is uniquely positioned to offer attractive, innovative

product designs to employers seeking to provide an

affordable yet comprehensive benefits package to their

employees. Health Plans also offers powerful, custom-

ized plan designs and state-of-the art reporting systems.

Health Plans’ membership revenue and profit have

more than doubled since the company was acquired by

Harvard Pilgrim. Much of the impressive growth can be

attributed to Health Plans’ reputation as the premier

hospital benefit administrator in New England. Case in

point: In 2005 Health Plans served four hospital clients.

Today, Health Plans acts as the TPA for more than

20 hospitals throughout the region.

Health Plans is constantly striving to broaden its

offerings. Most recently, the company managed the

acquisition of MedWatch, a Florida-based medical

management company presenting care management

services to self-insured employers and third-party

administrators nationwide. MedWatch, a URAC-certified

medical management company, offers a full spectrum

of care management programs, including case

management, disease management and utilization

review.

2013 Financials Harvard Pilgrim Health Care, Inc. and Affiliates (unaudited)

Combined Statutory Statements of Revenue and Expenses

For the years ended December 31, 2013 and 2012 ($ in thousands)

2013 2012

Revenue - Premium Income $2,632,821 $2,660,539

Operating Expenses

Medical Costs 2,249,193 2,278,419

Claim Adjustment Expenses 80,930 82,995

General Administration Expenses 301,522 293,928

2,631,645 2,655,342

Underwriting Income 1,176 5,197

Other Income and (Expenses)

Net Investment Income 22,889 24,638

Interest Expense (3,737) (4,432)

Other (521) (2,950)

18,631 17,256

Net Income $19,807 $22,453

Combined Statutory Balance Sheets

As of December 31, 2013 and 2012 ($ in thousands)

Assets 2013 2012

Cash and Securities $845,222 $872,928

Net Premiums and Other Receivables 122,658 112,487

Net Fixed Assets 41,072 41,562

Intangible Assets 4,784 5,739

Other Assets 39,971 25,446

Total Assets $1,053,707 $1,058,162

Liabilities and Net Worth

Liabilities

Claims Payable and Accrued Medical Incentive Pool $220,603 $249,203

Accounts Payable and Accrued Expenses 173,997 189,450

Premium Received in Advance 63,190 50,679

Other 34,659 37,061

Total Liabilities 492,449 526,393

Statutory Net Worth 561,258 531,769

Total Liabilities and Net Worth $1,053,707 $1,058,162

Harvard Pilgrim Health Care Mission

To improve the quality and value of health care for the people and the communities we serve

Core Values

Integrity

We treat others fairly and honestly — the same way we would want to be treated.

Trust

We collaborate and build trust through open, honest and respectful communication.

Innovation

We find creative, new ways to bring value to the marketplace.

Excellence

We expect the best from ourselves and strive to maximize value and service for our constituents.

Inclusion

We value difference and create value through difference.

Community

We make a positive difference in the communities we serve.

People

We succeed by building a talented workforce and caring about our employees and their families.

Accountability

We do what we say we will do and lead by example.

Another creative partnership: Editorial: Harvard Pilgrim Marketing Communications | Design: Yellow Inc. | Photography: Webb Chappell | Printing: Universal Wilde

Harvard Pilgrim Health Care Foundation

93 Worcester Street, Wellesley MA 02481

Harvard Pilgrim Health Care Institute

133 Brookline Avenue, Boston, MA 02215

Health Plans, Inc. Headquarters

1500 West Park Drive, Suite 330

Westborough, MA 01581

MedWatch, LLC

120 International Parkway, Suite 220

Lake Mary, FL 32746

Harvard Pilgrim Health Care

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, Suite 700, Manchester, NH 03101

1.888.888.4742

www.harvardpilgrim.org

Harvard Pilgrim Health Care includes Harvard Pilgrim Health Care, Harvard Pilgrim Health Care of Connecticut, Harvard Pilgrim Health Care of New England and HPHC Insurance Company.