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Partners confirms talks with insurer Harvard Pilgrim

The move is to adapt to a changing healthcare environment as insurers and providers increasingly share financial risk, Partners spokesperson says.

Susan Morse, Senior Editor

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Partners HealthCare is discussing a potential deal with insurer Harvard Pilgrim Health Care to create one of the largest integrated provider- and payer-based organizations in Massachusetts.

While The Boston Globe, the original source for the story, called the potential deal a merger, Partners spokesman Rich Copp would only confirm that Partners and Harvard Pilgrim are exploring ways to work together.

[Also: Harvard Pilgrim and AstraZeneca sign contract that charges less if Symbicort doesn't work as it should]

"As the healthcare environment changes, as insurers and providers increasingly share financial risk, traditional relationships are shifting," Copp said. "Partners is constantly exploring new relationships with the goal being to improve the patient experience, improve quality of care and better control medical spending."

No one from Harvard Pilgrim immediately returned a request for comment.

Partners HealthCare is a large Boston-based system founded in 1994 by academic medical centers Massachusetts General Hospital and Brigham and Women's. It includes at least a dozen hospitals and medical facilities, but only one health plan.

Harvard Pilgrim fits the bill as an insurer which has collaborated with providers to take on the challenge of population health data to lower cost.

In 2015, Harvard Pilgrim Health Care joined forces with New Hampshire hospitals Dartmouth-Hitchcock, Elliot Health System and Frisbie Memorial to create analytics company Benevera Health. Clinicians use the data in proactive care intervention for a population of about 80,000 Harvard Pilgrim beneficiaires in New Hampshire, Harvard Pilgrim said at the time. Benevera has since expanded to include St. Joseph Hospital, which is also located in New Hampshire.

In April, Harvard Pilgrim announced it had entered into its third outcomes-based pharmaceutical contract to tie drug payment to patient care. It signed an agreement with AstraZeneca for Symbicort, which is used to treat asthma and chronic obstructive pulmonary disease.

"These contracts hold the promise of curbing the escalation in pharmacy costs, while improving the health of our members.  However, uncertainty about the national health policy creates challenges for the health insurance industry," CFO Charley Goheen said in a March statement on 2017 financial results.

However, those results also showed a bleak financial picture for 2017. Harvard Pilgrim reported a net loss of $8.7 million and an operating loss of $28.3 million on revenue of $3 billion for the year. Losses were also reported in 2016.

Goheen said that results were better than what was budgeted, and that Harvard Pilgrim would continue to make investments to diversify its business both geographically and by product offering.

Membership dropped in the not-for-profit health services company founded by doctors. Between 2016 and 2017, Harvard Pilgrim's total membership decreased from 1.28 million 1.22 million.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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