The HMO plan offered by Harvard Pilgrim Health Care in Massachusetts, New Hampshire and Maine has been recognized for its commitment to excellence under the new J.D. Power and Associates Distinguished Health Plan Program.SM This award acknowledges Harvard Pilgrim for providing an outstanding experience to their HMO members. Eligibility for distinction was determined by surveying a random sample of Harvard Pilgrim’s HMO members on their perceptions of their health plan service experience and comparing the results to the national benchmark established by the J.D. Power and Associates 2003 National Managed Care Service Performance Study.

The research conducted recently among Harvard Pilgrim’s HMO members focuses on the six key drivers of member satisfaction with their overall health plan experience. These drivers, which were identified in the national study, include: provider choice, claims processing, information provided, preventative care services, approval process, and customer service interactions.

“Based on the rigorous standards of our national managed care research, which provides the qualifying benchmarks for the Distinguished Health Plan Program, only 20 percent of the health plans in the nation are expected to achieve this distinction,” said Steven D. Wood, Ph.D., executive director of the healthcare division of J.D. Power and Associates. “Harvard Pilgrim is the first health plan to be recognized with this elite distinction for service to HMO members in all three states—Massachusetts, New Hampshire and Maine.”

The Harvard Pilgrim Health Care HMO notably exceeded the national benchmark study score for overall member satisfaction. The health plan performed especially well in the area of provider choice, particularly in regard to its selection of primary care providers and the convenience of hospital locations.

Harvard Pilgrim’s HMO also performed very well relative to the national study in the area of approval processes. Members specifically gave the HMO high marks on the time it takes to get a specialist referral and the ease of obtaining authorization for hospital admission or procedures.

Additionally, members were asked to rate their likelihood to reenroll in the plan. Among Harvard Pilgrim’s HMO members, the proportion expressing a high likelihood to reenroll was higher than the national norm.

Members were also asked to rate their likelihood to recommend the plan to others. Among Harvard Pilgrim’s HMO members, the proportion expressing a high likelihood to recommend their plan was notably higher than the national norm.

“The Harvard Pilgrim HMO received this distinction by providing its members with a consistent, positive experience,” Wood said. “With consumers seeking more and better information to make educated healthcare decisions, this distinction allows Harvard Pilgrim and other top-performing health plans to effectively communicate this outstanding accomplishment in the communities they serve.”

Health maintenance organizations (HMO), point of service plans (POS) and preferred provider organizations (PPO) are eligible for the J.D. Power and Associates Distinguished Health Plan recognition. Distinction is valid for one year, after which the health plan may apply for re-certification. The 2003 National Managed Care Service Performance Study is based on a survey of more than 3,600 health plan members across the country.