The Group Insurance Commission (GIC) and Harvard Pilgrim share a history of developing innovative health care delivery programs and models that improve quality and access to care, educate and empower health care consumers, and contain costs. We’re working together again to improve the health care marketplace through the Integrated Risk Bearing Organization (IRBO) Initiative.
The initiative seeks to change the health care marketplace to achieve the triple aim of better health care, better population health, and lower per capita costs. At the heart of the initiative is Centered Care, an approach to health care delivery that encourages improved care coordination, access to care, disease management, and data sharing and analytics.
As a leader in clinical quality for more than 35 years, Harvard Pilgrim has developed exceptional preventive care, disease management, and clinical quality programs, as well as sophisticated quality incentive programs and tools to measure and evaluate performance. Harvard Pilgrim is actively collaborating with physician groups to expand these programs and develop new standards that support the principles of the IRBO Initiative and Centered Care—and better meet the needs of GIC employees.
The IRBO Initiative emphasizes the following elements:
- PCP designation and engagement
- Reporting and data sharing
- Use of low cost providers
- Referral pattern management
- High touch care for the chronically ill
- Disease management
- Convenient and easy access to care
- Effective transition care management
- Quality programs
- Monitor progress for IRBOs to market to members
- Monitor IRBO performance
- IT infrastructure
- Meaningful use criteria
Upcoming issues of Network Matters will include brief articles exploring some of these topics and Harvard Pilgrim’s related programs. Below we provide an overview of PCP selection and engagement. The GIC’s “10 Key Elements of an IRBO” explains to members how these elements come together to benefit their health and wellbeing in an IRBO that practices Centered Care.
PCP Designation and Engagement
PCPs play an essential role—helping patients stay healthy, arranging for additional health services needed, and coordinating care to ensure that other physicians are aware of the patient’s medical history. PCPs are at the hub of the Centered Care initiative.
The GIC and Harvard Pilgrim have efforts underway to educate GIC employees about the importance of having a PCP. In the fall, the GIC’s For Your Benefit newsletter included an article on this topic. In the first quarter of this year, Harvard Pilgrim will be mailing letters to GIC members similarly underscoring why members should select a PCP.
On Harvard Pilgrim’s online Learning Center, members can find a short video presentation:
- Emphasizing the importance of a PCP
- Offering tips on finding a PCP that’s right for them
- Explaining how to use HPHConnect to choose or change their PCP, view benefits and claims information, take a health questionnaire to improve health, or send questions to member services.
Additionally, our Provider Manual outlines PCP requirements and our member communications (enrollment materials, cover letters, and web copy) highlight the value of selecting a PCP to oversee and coordinate health care. For example, an article in the 2013 issue of the member magazine Your Health, explained the importance of discussing any specialty care needs with a PCP first, emphasizing that working with a PCP can help ensure smooth communication of vital health information among clinicians and result in better coordinated, higher quality care.
Look to future issues of Network Matters for additional articles on the IRBO Initiative and Centered Care.