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 New Hampshire and Maine. It has more than 1 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.
The Wellesley, Massachusetts-based company operates in and around Massachusetts, Maine, and New Hampshire.
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.
The Harvard Pilgrim Foundation provides community health and wellness programs.
Harvard Pilgrim's revenue fell 3% in 2012 compared with 2011, to $2.7 billion. Net income declined 76% over the same period to $22.5 million. In 2012 total membership for Harvard Pilgrim grew for the ninth consecutive year to 1,187,000. The company is under pressure to keep premiums for consumers and employers as low as possible, putting a squeeze on profits.
Harvard Pilgrim's plans are primarily offered to corporate groups. The company's primary goal is to maintain a loyal customer base while attracting new clients. 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.
It 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 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 February 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.