Harvard Pilgrim 11/7/2006

" Health care and health insurance topics on everyone's mind these days hello I'm -- Fritz and we're talking with Charlie baker the CEO of Harvard pilgrim health care one of the country's leading nonprofit health plans lot of plans in a lot of changes going on throughout the industry changes that affect you and me. Charlie you've been with the Harvard pilgrim since 1999 tell us how Harvard pilgrim has grown."

" Since you got there and what lies ahead alright I think the best thing I can say about what's happened over the last few years of Harvard pilgrim as we've been expanding our. Product offerings when when I got the Harvard pilgrim we had about 30000 PPO members and PPO products or products that don't require referral from primary care doctor -- special assistant we now have about 275000 members in PPO products we also have another 700000 in traditional HMO plans. And most of our business was fully insured at that point in time and a lot of employers have been interest and self insured options where they take a 100% of the risk associated with the cost of their. Medical expenses and we basically just manage the benefit the network form. We've had a significant increase in our self -- book is well aware of 4567 years ago. Probably if we have four fully insured members for everyone self -- member an -- to the point where it's pretty much won the one we have when fully insured for everyone self insured the other big differences we mostly sold and Massachusetts. For five years ago and now we have coverage of the extends pretty broadly into the whole state of New Hampshire in the whole state of Maine and we have to stay -- miller from Rhode Island. And through some of our partnerships we've managed to create national capability as well and we actually have almost 7000 members now in our service area who were part of employers who cover the entire. Country so they're -- some significant changes so."

" In the past if if I was a member of Harvard pilgrim health care plan and and I were sick in Las Vegas or some other state. I would hope that if you got sick of Las Vegas -- be able to find something other than wearing -- like health care and that's -- about it that's true but now it's not a concern right the the network Renault have that we can make available to people nationally is in fact. A national network covers all 50 states do you do you find that helpful in him attracting business owners."

" Absolutely I mean one of the things. That's happened particularly using Internet has developed is most employers now even small ones have a national customer base and a German national customer base you need to be where your customers are so. Even companies with 23400 employees now tend to have operations and sales forces and service capability located over the country me when he outside of sort of state municipal employers and colleges and universities and health care providers most of the rest for the employer community at this point is is -- national most of the time because that's for their customers --"

" You know the -- Massachusetts health care reform law is now in effect here in the commonwealth do you feel that he's regarded as a result I certainly don't and I don't know -- little down the road to be honest with you. But have audio what are what are your thoughts Amir yerba a CEO will be helped"

" the -- I would say three things the first is that the folks have been involved in implementing this program which basically was past five months ago coming creating the capability to roll the first populations that they need to -- to -- job. -- of translating a concept into an operating model I think between you know the -- of care program which is for low income people who work but aren't poor enough to qualify for Medicaid that's the program that's kicked off today and there's another piece of -- kicks off in January. And then the programs will be available for people who buy coverage individually -- part of small groups which will be available through something called the connector come July of next year. These are all very positive and I think significant developments in the right direction here in Massachusetts I think the other thing I'm very excited about his legislation created a cost and quality council. To basically try to make quality data and cost data around health care available to the public can -- one of the big problems we have with health -- there isn't any cost and quality data. In the public domain and as a result people who really know what your provider employer for a consumer who's really good of some things -- who's really good in other things because we just don't put that information in the public domain but into this constant quality -- to do that I think that will help a lot with the affordability and accountability issues that people have with health care. The the other thing I think is important run on this one is we have a gubernatorial election coming up and the next governor's going to have a lot to say about how health care reform gets implemented you know the current governor had a lot to do with the legislature in sort of drawing the framework for this. But the next governor's really you know on the implementation of it and that I think means it'll be him"

" I think the big issue for us is that as the cost of health care has risen driven by a lot of things new technologies new capabilities an aging population cutbacks in Medicare and Medicaid and the like people have been asked to incurred greater share financial accountability for their cost of health care. We've seen this happen and other sectors -- pharmacy and happened over the course the past five or ten years we're starting to see more of that now -- the medical side and I think for us the big issue is if people are going to have a greater share financial responsibility for their health care what we want to do is make sure we make data and information available to them they can help them make good choices. And that's part of the reason why we've been such big advocates more cost and quality data in the public domain generally and we've also been very aggressive about making more -- kind of information available to our members either through members services or through war. Website or through other mechanisms that we make -- I was gonna say Natalie get that information if I'm looking for how to go about finding some of it is on our website some of being get from member services we do a lot of outbound calls now with members service we -- people. Farmer free used to be a source and around with for the floundering in elements of the questions on the call we now call people who fall into certain categories to make sure they understand other benefits working to see if we can help them come with their particular circumstances how many different plans -- you have -- thousand -- can literally get out all of your right now maybe I'll just -- with a lot many many many am and I think one of the things that's. That's been a big part of our strategy has been the last few years which is to basically. Try to get to the staples Mona on this which as you know we got that I think that's when it to my campaign trail splits with but the notion of you know if you if you if an employer or -- Bora -- or remembers looking for particular. Solution we want to be able to make it available to pursue meals at about the senior product one that would have to do with like retiring in French right which someday may do -- native yeah eventually hopefully. Our senior product what we're basically doing is trying to combine the best of Harvard pilgrim on the service and products things with the Medicare. Network Medicare provider network is gigantic it's the biggest provider network in the in the country it's all 50 states it's. Virtually every provider in every state in every region and basically what we're doing is offering. The Medicare plan that we'll have comprehensive benefits serviced and supported the way Harvard forum best -- in the country in terms of service and support services and supports it. In mass New Hampshire and Maine but the network will basically be the Medicare network working with the Medicare rules Medicare standards and that means that if you're one of those snowbird suspends. Embassy here and in New England and 34 months a year down in Florida you'll be able to stay with. Us all the way through that process and just use the Medicare and network in Florida woman and that on your behalf appear in terms of the server -- so would you years ago you hadn't been able to do right we think this is going to be huge opportunity for seniors who really want to combination of that big broad national Medicare network. And Harvard pilgrim's impeccable reputation and credibility room service."

" Would you say that the biggest challenge for you besides the one that you just mentioned but another challenge would be to make sure the jury little attract. The boomers who were about ready to retire."

" Yeah I actually think this new product from talking about is going to be very attractive for the boomers they're going to like going to get their travelers a threat you know -- via a broad access to a broad network and I think this will work really well for them -- not your typical retiree know when they're going to totally change the notion of the service model to and that's one of the things we feel really good about because we believe service is in fact the hallmark of what we do we believe the one of the things were really good -- solving problems when people have -- and and we think the boomers have particular going to put a lot of value and that going forward in the we're going to look very attractive to them as a result."

" Very good Charlie baker CEO of Harvard pilgrim health care thanks for taking time to chat about these issues -- bureau thank you"