Care management

From care coordination and planning to chronic and complex condition support, our clinical care team works collaboratively to ensure our members can access care and receive needed support. 

Clinical care team overview 

All members have access to health care professionals who are certified care managers, wellness coaches, licensed social and behavioral health workers, and nurse educators specializing in diabetes, pediatrics, asthma and cardiology.

What sets our team apart is a distinct “whole person” approach that goes beyond just medical needs—they consider behavioral, pharmacy, health and wellness, and socio-economic needs too.

Members have high regard for the program and the care team – with a 91% satisfaction rating.*

Our team reaches out to members when and how it’s best for them—at home, work or on the road—whether by phone, email or mobile applications.

By building personal connections and trusted relationships our team guides members to better health, reduced risk and lower costs.

Engaged members provide an estimated (average) savings of $564 PEM/PM.*

Our programs

All Harvard Pilgrim plans, whether fully or self-insured, include our industry-leading programs aimed at supporting members wherever they are in the continuum of health—at no additional cost.

Our programs range from helping members living with conditions such as asthma, diabetes, heart disease and COPD—to those at risk for hospitalization due to multiple conditions and diagnoses—to those who could benefit from lifestyle support programs, such as pregnancy, smoking cessation, nutrition and weight management.

Provider collaboration

Our value-based provider contracts and deep partnerships also drive better health and deliver greater value. Our team of health care professionals work together with the member’s primary care provider to connect them to programs and services to put them on a path to better health.

Learn more

Contact your Account Executive for more information about our Care Management Programs.