Improving health care. Together. Harvard Pilgrim maintains a robust quality improvement program, working with providers on quality initiatives that include both clinical and service improvement projects. Every year, Harvard Pilgrim sets a quality improvement agenda, monitors its progress, and evaluates its effectiveness. We also host a Quality Grant program to fund innovative projects that support clinical practice transformations, cross-discipline integration, and effective care transitions.

With our mission statement as a guide — “To improve the quality and value of health care for the people and communities we serve” — Harvard Pilgrim develops quality programs that focus on member and community health improvement while simultaneously improving the value of health care. Through our Quality Program, we strive to ensure the delivery of consistently excellent health care, health information, and customer service to Harvard Pilgrim members. This aligns with Harvard Pilgrim’s overarching goal of enabling members to maintain and improve their physical and behavioral health and wellness.

Quality of care and patient safety are of the utmost importance to us, and keeping accurate, up-to-date medical record documentation is crucial to providing good patient care. Harvard Pilgrim sets standards for medical record documentation, availability, and confidentiality, which you can review below.

Harvard Pilgrim reviews hospital quality outcomes reported on Hospital Compare, including measures related to timely and effective care, patient experience, readmissions, mortality, surgery, and health care associated infection.

The National Committee for Quality Assurance (NCQA) measures the clinical quality performance of health plans nationally, using standardized measurement criteria known as the Healthcare Effectiveness Data and Information Set (HEDIS). The criteria is used to assess performance in a variety of areas, including effectiveness of patient care, access and availability of care, patient experience, and management of health conditions.Your cooperation in providing certain data helps ensure that our HEDIS measures accurately reflect the high quality of care that our provider network delivers to members.

2018 HEDIS Results