Harvard Pilgrim Health Care takes care of New Englanders. A leading provider of health benefits in Massachusetts, the not-for-profit organization also offers plans to residents of Connecticut, Maine, and New Hampshire. It has more than 1.2 million members enrolled in its HMO, PPO, point-of-service, and government plans. Those members have access to regional and national networks of hospitals and doctors. Harvard Pilgrim also targets multi-state employers with its Choice Plus and Options PPO plans, offered through a partnership with UnitedHealthcare. Founded in 1969, Harvard Pilgrim has a network of more than 135 hospitals and 28,000 doctors and clinicians.
Additionally, the company collaborates with Harvard Medical School to perform research that is focused on health care systems (treatments and costs) and patient populations through the Department of Population Medicine within its Harvard Pilgrim Health Care Institute (which includes Harvard Pilgrim Health Care of Connecticut and HPHC Insurance Company). Another Harvard Pilgrim subsidiary, Health Plans specializes in administering self-insured or administrative services only plans for employers.
The Harvard Pilgrim Foundation provides community health and wellness programs.
The Wellesley, Massachusetts-based company operates in and around Connecticut, Massachusetts, Maine, and New Hampshire.
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The company provides its services to individual, group, and Medicare members through contracts with physicians.
Harvard Pilgrim's revenue fell 1% to $2.8 billion in 2013 versus 2012, primarily as a result of lower premium and investment income. Net income declined 29% over the same period to $20.7 million, due to declines in unrealized gains on investments. In 2013 total membership for Harvard Pilgrim grew for the tenth consecutive year to 1,200,000. The company is under pressure to keep premiums for consumers and employers as low as possible, putting a squeeze on profits.
Cash flow from operations decreased 46% to $57 million in 2013, largely because the company increased cash used in claims payable and accounts receivable; declines in cash generated by accounts payable and expenses also impacted its cash flow.
Harvard Pilgrim's plans are primarily offered to corporate groups. The company's primary goals are to lower costs, improve care, and enhance its members' overall experience. In support of its ambitions, Pilgrim Health has expanded the breadth of its plan offerings and widened its network of contracted health providers to maintain its competitive edge. In 2014 the group improved its Medicare Advantage Stride (HMO) offerings and launched new benefit programs in certain markets; it intends to expand the service area for the programs in 2016.
Harvard Pilgrim also enrolls Massachusetts residents in low-cost coverage plans as part of the state's mandate, passed in 2006, that requires every resident to have health insurance. The company also manages New Hampshire's Healthy Kids program, which covers low-income children.
In 2014 the company received approval to begin offering health coverage to consumers in Connecticut.
In addition to its direct insurance offerings, the company provides third-party administrative services for self-insured plans through its Health Plans subsidiary. It has been growing this part of its business through acquisitions, including the purchases of regional third-party administrators.
Mergers and Acquisitions
In early 2014 Harvard Pilgrim acquired Florida-based MedWatch, a provider of care management service to third-party administrators and self-insured employers nationwide. The medical management firm has more than 94,000 members nationwide. The company also acquired Western Connecticut Hospital Network, adding to its list of providers.