Health care expenditures continue to rise. However, health insurers, such as Harvard Pilgrim Health Care, are finding innovative ways to reign in costs without sacrificing consumer experience.
According to Harvard Pilgrim’s Kate Wallis, vice president of population health and clinical operations, health plans are uniquely equipped to find solutions that strike the balance between cost and care.
“We have a comprehensive view of members’ care and the services they are using, whether it’s medical, behavioral health or pharmaceutical,” says Wallis. “This, along with care management data, allows us to identify where the coverage gaps are and guide us to the right initiatives.”
These include innovative utilization management programs that tackle specialty pharmaceutical medication, as well as chemotherapy and radiation therapy programs that focus on minimizing patient side effects, unnecessary toxicity and over utilization, while also producing a provider satisfaction rate of 96%.
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It’s important to find programs that not only address cost drivers, but are collaborative between doctors, patients and health plans, adds Beth Roberts, senior vice president of commercial business at Harvard Pilgrim Health Care.
“Providers and health plans are working together to ensure the member is getting the best care out of the gate in an affordable care pattern, which means it’s a winning experience for all involved,” adds Roberts.
Listen to learn more about specific cost containment programs that are delivering results and keeping the patient experience front and center.
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