Harvard Pilgrim launches shared-risk, narrow network plan

Harvard Pilgrim is partnering with two of New Hampshire's largest hospital systems in a shared-risk collaboration that will offer a narrow network plan boasting coordinated care, the organizations announced Monday.

The plan, called ElevateHealth, is a joint arrangement between Harvard Pilgrim and New Hampshire's Dartmouth-Hitchcock and Elliot Health System that aims to lower premiums by 10 percent compared to Harvard Pilgrim's full network plans, according to the announcement.

To cut costs, the hospitals are taking lower reimbursement rates from Harvard Pilgrim, and all three organizations will all share in any profits achieved. And ElevateHealth's provider network is limited to about 400 primary care doctors and 2,600 specialists between the two providers' facilities.

"For all too long in the health system today, there has kind of been an arm-wrestling going on between health plans and hospitals and physicians, trying to negotiate the highest dollar or the lowest dollar," Harvard Pilgrim CEO Schultz said at a press conference Monday announcing the program, reported the New Hampshire Public Radio.

The plan also will coordinate care using nurses who act as "navigators" for patients. For example, the care coordinator would be alerted if a family frequently brings a child to the emergency room for asthma and could then help the family control the condition. "It sounds simple and it is simple, but it's also quite effective," Schultz said, according to the Concord Monitor.

The plan will be available to small and large employers beginning in December, but it might become available on New Hampshire's health insurance exchange in 2015.

To learn more:
- here's the announcement (.pdf)
- read the New Hampshire Public Radio article
- see the Concord Monitor article