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 some 1.3 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.
Harvard Pilgrim also 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 plans for employers.
The Harvard Pilgrim Foundation provides community health and wellness programs.
The Wellesley, Massachusetts-based Harvard Pilgrim operates in and around Connecticut, Massachusetts, Maine, and New Hampshire.
Sales and Marketing
Harvard Pilgrim provides its services to individual, group, and Medicare members through contracts with physicians. In all, it serves some 2.7 million customers.
Harvard Pilgrim had revenue of $2.7 billion in 2015, an 8% increase over the prior year. However, the company had a net loss of $54.8 million in 2015, down from a net gain of $8.4 million in 2014. It attributed the losses to the impact of the Affordable Care Act's risk adjustment provisions -- it made significant risk adjustment payments related to operations in most markets -- as well as rising pharmacy costs.
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. For example, in the past couple of years, it has expanded into the Connecticut and Medicare Advantage markets.
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.
The company is also focused on improving wellness across the health care spectrum to ultimately lower costs for its members. Its EatRight Rewards program rewards members for choosing healthier options at the grocery store, while its CAPE (Critical Care, Anesthesia, Perioperative Extension & Home Ventilation) program provides ventilation-dependent children with home care to reduce medical emergencies and hospitalizations. Harvard Medical also supports alternative treatments such as acupuncture in order to promote diversity, as well as initiatives to bring healthy foods into underserved communities.
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.