Multiple factors affect earnings

(Wellesley, MA) – Harvard Pilgrim Health Care today reported a net loss of $48.5 million and an operating loss of $91.3 million on revenue of $3.1 billion for the year ended December 31, 2016. For the same period in 2015, the health plan reported a net loss of $54.8 million and an operating loss of $78.8 million on revenue of $2.7 billion.

Harvard Pilgrim’s total membership for the fourth quarter of 2016 grew to 1,281,246 from 1,266,876 in the fourth quarter of 2016.

For the fourth quarter of 2016, Harvard Pilgrim reported a net loss of $1.6 million and an operating loss of $33.5 million on revenue of $740 million. For the same time period in 2015, Harvard Pilgrim reported a net loss of $39.7 million and an operating loss of $41.5 million on revenues of $698 million.

The 2016 losses reflect sharply increasing medical utilization, higher pharmacy costs and continuing challenges related to the ACA, including the impact of the special enrollment period and the risk corridor and risk adjustment programs.

“Our year-end results reflect a number of external factors that the health insurance industry has been facing,” said Chief Financial Officer Charles Goheen. “We have invested in medical and administrative cost improvement programs and completed installation of our new core technology system. With significant expansion investments in Connecticut and the Medicare Advantage program and alignment of sustainable growth strategies in all of our markets, we are forecasting a significantly improved 2017.”

About Harvard Pilgrim Health Care
Harvard Pilgrim is a not-for-profit health services company that, along with its subsidiaries, is improving the well-being of its 2.7 million customers. Harvard Pilgrim’s flagship health plans in New England provide health coverage to 1.3 million members, while another 1.4 million individuals are served through Health Plans, Inc., a subsidiary that provides integrated care management, health coaching and plan administration solutions to self-funded employers nationwide. Founded in 1969, Harvard Pilgrim has built its reputation on innovation and collaboration with a goal of lowering health care costs, improving care and enhancing the overall member experience. It is known for its excellent clinical programs, customer service, health improvement strategies and innovative tools that offer consumers greater transparency and empower them to make better decisions about their health care. Harvard Pilgrim is home to the Harvard Pilgrim Health Care Institute, a unique collaboration with Harvard Medical School. As Harvard Medical School’s Department of Population Medicine, the Institute is the only appointing department of a U.S. medical school housed within a health plan. Funded primarily through external government and private sources, it provides critical information to all levels of our health care system on issues affecting population health and health care delivery. Harvard Pilgrim is consistently among America’s highest-rated health plans according to an annual ranking of the nation’s best health plans by the National Committee for Quality Assurance (NCQA)*.

*Harvard Pilgrim Health Care (private HMO/POS and PPO plans) and Harvard Pilgrim Health Care of New England (private HMO/POS plans) have been rated 4.5 out of 5 in NCQA’s Private Health Insurance Plan Ratings 2016-17. NCQA’s Private Health Insurance Plan Ratings 2015-16. NCQA’s Private Health Insurance Plan Rankings, 2011-15, HMO/POS/PPO.

Harvard Pilgrim Health Care
Joan Fallon
(617) 509-7458
joan_fallon@hphc.org