Quality

Learn about quality and how Harvard Pilgrim partners with members and providers to improve the quality of your care.

What is “quality health care”?

Quality health care means doing the right thing, in the right way, at the right time, for the right person, and having the best possible results.

How does Harvard Pilgrim support quality health care?

We support quality health care by:

  • Participating in National Committee for Quality Assurance (NCQA) quality initiatives
  • Making sure the health care professionals and hospitals in our provider network have the right qualifications and meet our high standards for providing care to our members
  • Offering tools that help you and your provider work together to make decisions about your care, such as our Make Better Health Decisions tool
  • Giving you access to digital platforms like Doctor On Demand, which offers convenient and timely access to urgent care providers
  • Providing your latest claims and billing information through your Harvard Pilgrim member account

How to make sure you’re getting top-quality care

To make sure you’re getting top-quality care:

Choose quality doctors

A primary care provider (PCP) is the doctor, nurse practitioner or other qualified medical professional you see for annual checkups and for treatment when you’re sick or injured.

We strongly recommend establishing a connection with and having regular visits with a PCP, even if you’re a member of a plan that doesn’t require you to have one, such as a PPO.

A PCP will:

  • Provide preventive and routine medical care
  • Refer you to participating medical specialists when needed
  • Keep a record of your care and know your health history
  • Ensure your continuity of care and prescriptions
  • Help you make informed decisions about your health
  • Educate you about healthy lifestyle choices

To help get the most out of your visit with a PCP:

  • Always bring your member ID card to appointments
  • Tell your PCP about any changes in your health
  • Make a list of your top health concerns
  • Bring a list of any medications or supplements you take
  • Be sure you can see and hear as well as possible, and take a friend or family member along if you need help
  • Ask for an interpreter, if you need one
  • Use decision-making tools to learn about treatment options for common conditions, and discuss these options with your PCP

If you don’t already have a PCP, you can find out which PCPs are available to you by using our online provider directory or by contacting Member Services at (888) 333-4742 or send a secure email.

It’s important to have a PCP you feel comfortable with. Our online provider directory lets you search by location, specialty, gender, hospital affiliation and other criteria.

You also may refer to the Harvard Pilgrim Physician Group Honor Roll, which recognizes physician groups that demonstrate a sustained commitment to providing exceptionally high-quality care to our members. PCPs who are affiliated with practices that received Harvard Pilgrim’s Quality Honor Roll award will have a red ribbon shown in their listing. 

The federal Medicare program and the Agency for Health Care Quality and Research also have helpful tools to use as you look into choosing a PCP. Your state’s Board of Registration in medicine may also be a valuable source of information:

To learn more about physician or physician group performance, visit one of these websites:

 

Choose quality hospitals

Harvard Pilgrim's network includes 182 of the area's most respected community, teaching and specialty hospitals. Many of these hospitals are recognized around the world for their excellence and high quality.

What is Harvard Pilgrim doing to identify high-quality hospitals?

  • Through their secure account, Harvard Pilgrim members can access information to help them prepare for procedures and compare hospitals based on location, procedure or condition, and on important indicators of patient safety and clinical quality of care.
  • To see if your doctor has admitting privileges at a particular hospital, use the Provider Directory and perform a "Quick search" for your doctor. Your doctor's listing will show thier hospital affiliations.
  • You can also contact Member Services to have a Provider Directory mailed to you. The directory includes lists of affiliated hospitals.

What you can do to choose a high-quality hospital
The U.S. Agency for Healthcare Research and Quality (AHRQ) suggests you ask the following questions when selecting a hospital:

  • Does my health plan cover care at the hospital?
  • Does my doctor have privileges at the hospital (is permitted to admit patients)?
  • Does the hospital meet national quality standards?
  • How does the hospital compare with others in my area?
  • Does the hospital have experience with my condition?
  • Has the hospital had success with my condition?
  • How well does the hospital check and improve on its own quality of care?

Additional information

Partnering with physicians

Providers and their office staff are the first and most important link in delivering the highest quality medical care. Harvard Pilgrim has created the following programs to encourage and reward best practices among physicians and physician groups:

Recognizing excellence. We publish an annual list of physician groups whose commitment to high-quality care has earned them the distinction of membership on our Physician Group Honor Roll for adult and pediatric practices.

Rewarding excellence. Harvard Pilgrim has built financial incentives into our contracts with physician groups to promote and reward their achievement of high levels of clinical and service quality on specific performance measures.

Quality grants program. We award grants to physician groups to help achieve two important quality improvement goals:

  • For practices to explore innovative strategies and programs to improve care in important clinical topic areas
  • For quality-improvement interventions in local practices that may face challenges to achieving our high-performance targets; these grants help practices address challenges such as language or cultural barriers, behavioral health integration, substance abuse solutions, palliative care strategies and more

Other practice support for providers. This includes offering:

  • Clinical guidelines and performance feedback
  • Shared decision-making aids
  • Patient handouts and support tools
  • Patient registry data and information for disease management

Supporting best practices within the care delivery system helps to further Harvard Pilgrim’s mission to improve the health of its members and the community at large.

Quality improvement program

Harvard Pilgrim is dedicated to maintaining a robust quality improvement program. Each year we set a quality improvement agenda, monitor our progress and evaluate our effectiveness. Read more about these efforts in these documents: