Harvard Pilgrim Health Care
Rate Justification for New Hampshire Individual Plans
Rate Change Effective January 1, 2024
Qualified Health Plan (QHP) issuers are required to post justifications for any QHP rate changes to their websites. Below, please find the justification for the rate change effective January 1, 2024 for the Harvard Pilgrim Health Care (HPHC) New Hampshire Individual QHP plans.
Drivers of the rate change
- A key driver of health insurance premium increases year over year is medical trend, which is comprised of inpatient, outpatient, and physician services as well as pharmacy costs. Medical trend includes both changes in the cost of the services provided by hospitals and physician groups and changes in the utilization of these services by our members. In particular, for 2024, Harvard Pilgrim expects continued upward pressure on medical unit cost increases, driven primarily by the higher inflationary environment and medical staffing challenges. Additionally, pharmacy trends continue to put upward pressure on overall claim trend, and this is expected to continue in 2024.
- Effective January 1, 2021, the New Hampshire Insurance Department began operating a reinsurance program with the goal of lowering insurer liability for Individual Plans. HPHC’s rates reflect the impact of this program.
Under the Affordable Care Act, at least 80% of premium must be used for medical expenses (otherwise, a rebate is paid to subscribers). The 2024 rates were calculated to comply with this requirement.
Harvard Pilgrim’s strategy to keep premiums affordable
Harvard Pilgrim Health Care is committed to improving quality and delivering increased value across the health care system. Today, we are focused in the following areas to support these strategic objectives:
- Establishing collaborative arrangements with health care providers to control costs and improve health outcomes
- Negotiating pharmacy contracts aligning payments with outcomes
- Managing chronic conditions and diseases through our nurse care managers
- Updating our payment policies to deter inappropriate payment for services on selected medical infusible drug claims
- Maintaining focus on reducing fraud waste and abuse
We remain committed to identifying opportunities to lower health care costs while providing enhanced value to our customers and health plan members today, and in the future.