Top plans stand out among close contenders


Harvard Pilgrim Health Care in Massachusetts has been calling itself "America's highest rated health plan" for the past several years. And it's got industry studies to back it up.

With my journalism background, I admit that I'm awfully skeptical about any person or organization that claims to be "the best." Often, the top contenders in any type of ranking are so closely matched that it's difficult to say one is truly better than the other. I also wonder about whether top performers can sustain their success or if their peak performances were brief, shining moments.

Ken Jennings, for example, is considered to be the best Jeopardy! player in history. There's no doubt he has gifted intelligence, but his streak ended when he flubbed an embarrassingly simple question in the final round. More recently on Jeopardy!, one set of contestants finished the game in a three-way tie and had to come back a second time to finally determine the champion (surprisingly, that's never happened before). It makes you think about how tricky it is to assign the label of "the best."

For example, its member services department is trained to resolve members' issues on the spot without the need to call back, Capozzi told me. "If you've ever dealt with customer service in the airline industry or the computer industry, you know it can be a hot, wrenching environment."

He says health plans that want to earn high marks need to guide all their departments to be solution-oriented and to create good first impressions. Harvard Pilgrim's sales team works with its clinical team to create comprehensive execution maps for each new customer/employer to avoid postimplementation problems. All too often, he says, it's the postimplementation phase that can make or break a customer's opinion of its choice in health plans. Mastering the implementation process can avoid a lot of preventable problems and free up senior management to spend more time on strategic matters, Capozzi says.


Consider the fact that just six years ago, Harvard Pilgrim was in trouble and had to turn its image around to remain competitive. There was a business case for performance improvement.

And apparently, they've succeeded. Harvard Pilgrim has been separately ranked number one by J.D. Power and Associates and the National Committee for Quality Assurance (NCQA) several years in row. In the J.D. Power report that just came out, the organization had a six-point lead over its next closest competitor on a 1,000-point scale; and in the NCQA ratings-which weigh clinical measures as well as customer service-Harvard Pilgrim took a five-point lead over its next competitor on a 100-point scale.

The opportunity for plans as a whole to improve service is growing to epic proportions-not just for the sake of earning high marks in ranking reports, but because the newly savvy purchaser is insisting on it. Consumers are wagering more and more of their income for healthcare, and each one of them wants to choose a winner.

Julie Miller is editor-in-chief of MANAGED HEALTHCARE . She can be reached at

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