20 Case Study—Harvard Pilgrim Health Care


HARVARD PILGRIM HEALTH CARE (HPHC) is a full-service health benefits company serving members throughout Massachusetts, New Hampshire, Maine, and beyond. HPHC's mission is “To improve the quality and value of health care for the people and communities we serve.”1 For over 40 years, HPHC has built a reputation for exceptional clinical quality, preventive care, disease management, and member satisfaction and has consistently rated among the top plans in the country.

HPHC has a strong reputation for being customer-focused and having a commitment to excellence. HPHC was ranked the number-one private health plan (HMO/POS) in America according to an annual ranking of the nation's best health plans by the National Committee for Quality Assurance (NCQA) for 2012/2013.2 HPHC is the only private health plan in the nation to be named number one for member satisfaction and quality of care for nine consecutive years.3 Harvard Pilgrim Health Care of New England, HPHC's New Hampshire affiliate, is the top-ranked plan in New Hampshire.

Summary of HPHC's business:

  • Not-for-profit health plan, based in Wellesley, Massachusetts
  • 1,100 employees across eight locations
  • Over one million members in Massachusetts, New Hampshire, Maine, and beyond
  • Full range of health insurance choices, funding arrangements, and cost-sharing options

Key business challenges faced

  • Emerging requirements for complex benefits (flexibility)
  • Increasing populations and complex ...

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