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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

March 2014

Centered Care: A Focus on Prevention 


Centered Care is a collaboration among the Group Insurance Commission, Harvard Pilgrim, and provider organizations that fosters many principles of the patient-centered medical home and Accountable Care Organizations (ACO). This approach promotes:

  • Comprehensive care — Bringing together a team of providers to be accountable for the patient’s spectrum of needs, including  prevention, disease management, care of the chronically ill, and transitional care management
  • Accessible care — Improving access to care through expanded hours, better scheduling, and urgent care access
    Patient-centered care  — Supporting patients in being well-informed, enabling them to make the best medical decisions and manage their own health, and respecting patient’s unique needs, culture, values, and preferences
  • Coordinated care — Encouraging the use of PCPs to organize and coordinate health care
  • Quality and safety — Demonstrating commitment to quality improvement through the use of performance data, HEDIS measures, clinical outcome reports, and other quality measures.

Wellness Programs

Harvard Pilgrim has a number of programs currently in place to support, and other provider organizations, in the delivery of centered care. This article provides an overview of some of our preventive care programs, which support the goals of comprehensive care, quality, and patient education and involvement.

  • Health coaching: Harvard Pilgrim offers free phone-based health coaching to our all members over age 18. Our certified health and wellness coaches work with members at their own pace to support their health goals, from managing high blood pressure to losing weight, eating a healthier diet to quitting smoking.  The coaches use motivational interviewing techniques to help members set realistic goals and influence them to make and stick with healthy changes. This program helps empower members to make informed health and wellness decisions, encourages them to take an active role in their health care, and provides them with the resources and skills needed to make healthy lifestyle choices. Getting a personal health coach is simple: members sign on to HPHConnect and indicate on the confidential health questionnaire that they would like to work with a coach.
  • Member outreach: Harvard Pilgrim regularly performs patient outreach to ensure routine preventive care to improve early detection of disease and subsequent outcomes. We target select members with specific messages based on their age, gender, and claims history. Our outreach (mailings, secure messaging, etc) includes but is not limited to reminders for the following preventive services:  mammograms, Pap smears, pediatric and adolescent immunizations, flu/pneumonia vaccinations, and diabetic eye exams.
  • HEDIS data for medical management: Harvard Pilgrim’s Quality Management Reports, which are available to medical leadership at LCUs and provider organizations, contain member- and PCP-specific information on various HEDIS measures for the practice. These reports help medical managers coordinate care and identify gaps in care. Reports provide information on members who have received or are due for certain screening or interventions (such as mammograms or immunizations), as well as members newly diagnosed with certain conditions (for example, diabetes, major depression or cholesterol management).
  • Health education courses: Harvard Pilgrim offers more health education programs than any other plan in New England — approximately 1,000 classes per year are offered at Harvard Pilgrim provider and nearby community locations.  Most programs are available to members at a discounted fee.
  • Resources: Harvard Pilgrim’s quarterly member newsletter, Your Health, includes health and wellness articles, health education course listings, and product and benefit information. Our website (www.harvardpilgrim.org) features a host of resources to help members find information on specific health topics and explore ways to improve their health, including risk calculators, guidelines, and interactive health tools.

 For more on centered care, please see this article from the January 2014 issue of Network Matters.

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HPHCURRENT EVENTS

Reminder: Centered Care Initiative & PCP Designation and Engagement

CLINICIAN CORNER

Centered Care: A Focus on Prevention

Updated Medical Review Criteria for H.P. Acthar Gel

Treating Depression in Older Adults

Members’ Rights and Responsibilities

OFFICE ASSISTANT

Ancillary Providers: Please Review Provider Directory Listing

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,
Editor

Kristin Edmonston,
Production Coordinator