Health New England staff have had a busy winter and spring. Although news about Harvard Pilgrim Health Care has affected our day to day business operations, we were able to complete several significant tasks. I would like to share these accomplishments with you.
StatusOne
In December, HNE signed a contract with a local (Hopkinton) company to help us identify and manage members at risk for frequent hospitalizations. Dave Boss, Associate Medical Director, and I have had the opportunity to speak to physician leaders in our risk units about StatusOne. The program is up and running and StatusOne is already helping all of us manage our high-risk patients, around 400 members currently. If you have questions about StatusOne, please call Dave or me.
Berkshires/VMG
HNE has entered into a delegation agreement with Commonwealth Health Management Services (CHMS), the administrative arm of Berkshire Physicians & Surgeons, for utilization management services to HNE members in the Berkshires, and with Valley Medical Group in Hampshire and Franklin counties. These delegation agreements are part of long-term contractual relationships. We believe these contracts will serve as a model for our relationships with provider groups going forward.
NCQA
On July 3, 2000, the National Committee for Quality Assurance (NCQA) awarded HNE its highest accreditation status of Excellent for its Commercial HMO and Point of Service product lines. NCQA completed its site visit from February 28 to March 2. The review process is rigorous, consisting of both on and offsite evaluations conducted by teams of physicians and managed care experts. The site visit was a culmination of months of hard work. I am extremely proud of our team effort and I want to thank again several of our network providers who graciously agreed to interviews with the site review team about HNE’s programmatic activities with the network. I wish to single out Alice Angelo, M.D., Ronald Burkman, M.D., Jay Pomerantz, M.D., and Ben Liptzin, M.D.
HEDIS®
We have recently completed gathering our HEDIS® data. As you know, all health plans initially use "administrative" (claims) data. However, again this year we supplemented the claims information with medical record reviews to assure we get the most accurate representation of compliance. Thank you for your help and cooperation. Also, I want to offer a special thank you to the Vice Chair of our Board, Dr. Richard Segool. Remember, only HNE’s HEDIS® scores truly reflect Western Massachusetts provider/network performance on routine preventive health measures.
Harvard Pilgrim Health Care (HPHC)
All Health New England employees have benefited from our relationship with Harvard Pilgrim. We are relieved that the DOI has recommended and the State Supreme Judicial Court has agreed to lift HPHC’s receivership, recognizing that Harvard’s financial difficulties are improving. At the same time, HPHC has agreed to sell its shares in the HNE Joint Venture to Baystate Health System. HNE and HPHC are currently in discussion to determine how we will operate going forward.
MedImpact
On June 15, HNE changed its pharmacy benefit manager from Pharmacare to MedImpact. Although this conversion was not "seamless", we look forward to a productive working relationship with this young, aggressive San Diego company. MedImpact is presently doing our prior authorization relieving HNE personnel of this administrative responsibility.
An Apology
CVS Pharmacy has apologized to our members, but I want to apologize to our providers. I wrote to you about the seamless change in our pharmacy benefit manager from Pharmacare (a wholly owned subsidiary of CVS) to MedImpact. Actually the change went smoothly from a technical perspective. Unfortunately HNE became an unwitting participant in a nationwide dispute about reimbursement between two giant companies, CVS and MedImpact. When these two companies drew the "line-in-the-sand" in Springfield, MA, our members, providers and employer accounts suffered. Fortunately CVS did change its corporate position after 36 hours, and we have welcomed the pharmacy chain back into our willing provider network. I regret the service disruption, the downside of any willing provider, and I hope that it never happens again.
