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

February 2015

Data Sharing Enhancements

Harvard Pilgrim strives to improve the quality and completeness of the data we make available to providers in our network. In support of the principles of Centered Care, we are committed to effectively managing medical costs, improving quality, enhancing transitions of care, and fostering strong collaborative relationships with our providers and members.

In order to help our provider groups manage care and medical trends, we deliver data and reports through two mechanisms to meet the needs of both sophisticated data operations and smaller provider groups. Large files, capable of being autoloaded to data warehouses, are available via the Secure File Transfer Protocol (SFTP); these include medical claims extracts, member and eligibility extracts, and financial performance reports. Providers can access other reports, including cost, utilization, authorization/notification, and disease management information, via the secure HPHConnect portal.

We understand the importance of making meaningful data as accessible and user-friendly as possible. Better information leads to better decisions, relationships, and results — a reality that continues to drive improvements to our reporting suite.

In October 2014, Harvard Pilgrim introduced several enhancements to our reports. Inpatient Census Reports were moved from a view-only PDF format to an interactive platform; new fields were added to Inpatient Discharge Reports, including attending physician; and Authorization and Notification Reports had new fields added that now allow drilldowns from high level to detailed patient rosters.

We also added a new category of reports to our Quality Measures Reporting (QMR), a report suite allowing users to see patient detail and health center summary performance in key HEDIS measures addressing acute, chronic, and preventive care. In addition to the retrospective view (a rolling 12 months), which includes a comparison to national and regional benchmarks, Harvard Pilgrim added a prospective (calendar year-to-date) view, enabling users to review current gaps in care and identify patients needing outreach to receive services in compliance with guidelines by the end of the calendar year.

More improvements are on the way in 2015. We are updating existing reports to reflect self-insured HMO and PPO memberships, and will be including PPO membership in the standard monthly membership roster available to providers, giving you the opportunity to better manage care across your patient population. These new features will be available in early spring.

Harvard Pilgrim will continue to make improvements to the quality and accessibility of the data we share with our providers. For more information on our medical informatics and the reports available to you, please refer to materials updated periodically at our provider LCU reporting web page.

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Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator