2018 Health Care Outlook

Alliance News |

By William C. Brewster, MD, vice president, New Hampshire market, Harvard Pilgrim Health Care

The outlook for 2018 will continue to be challenging for the health care industry as we seek ways to improve the quality of care while managing rising costs.

Fighting the Opioid Crisis

The headlines are tragic. Every day there’s another story on an individual and their family who have been affected by the opioid crisis here in New Hampshire and across the country. Harvard Pilgrim has seen the impact of drug abuse disorder on our members and their families, and we are committed to being part of the solution. Some of the ways we are addressing this issue are:

  • Eliminate any member cost share for filling a prescription for naloxone, which can be life-saving in the event of an opioid overdose.
  • Work with providers to help prevent over-prescribing of prescription opiates.
  • Support a range of evidence-based treatments for those dealing with substance abuse and for the treatment of pain, such as acupuncture.
  • Broaden approaches such as mindfulness and therapeutic yoga as viable alternatives to narcotics, including working with providers in these disciplines who have explicit experience in pain management.
  • Develop specialized care management programs to keep our members on the path of treatment and recovery.
  • Cover all forms of medication-assisted treatment (MAT) without the need for prior authorization. Earlier this year, we added Methadone maintenance as a covered treatment.

We should never lose sight of our ability to influence the quality of care delivered. Continuing to demonstrate leadership in combating the opioid crisis is more important than ever, and will be a focus for our health services in 2018.

Containing Costs and Improving Quality of Care

In “The State of Aging and Health in America 2013,” the Centers for Disease Control and Prevention reported that two in three older Americans have multiple chronic conditions – e.g., arthritis, coronary heart disease and diabetes – and that treatment for people with multiple chronic conditions represents 66% of the nation’s health care budget.

By anticipating the needs of members and patients we can take a proactive approach in overseeing their care.

One example of this is Benevera Health – a New Hampshire-based care management company formed by Dartmouth-Hitchcock, Elliot Health System, Frisbie Memorial Hospital, St. Joseph Hospital and Harvard Pilgrim. It is a promising example of how technology and the human touch can improve health outcomes and keep spending low.

Using best-in-class data analytics, Benevera Health identifies members who could benefit from care management. They engage at-risk patients for care coordination early, before their health is problematic.

Patients dealing with serious illnesses may also be dealing with serious socioeconomic, behavioral and environmental roadblocks that can affect their health. Benevera Health’s approach is to look at all the factors that contribute to the patient’s well-being and not just their disease. The team of nurses, social workers, a pharmacist and community health workers helps people with their medical, behavioral, social and financial needs because they know that health is only possible when a person is medically stable, socially connected, food and housing secure and financially at ease. So far, this approach is working and is a positive, forward-thinking approach to effectively and affordably managing the health of New Hampshire residents.

Innovative Drug Cost Management

According to a 2016 Kaiser Family Foundation Health Tracking Poll, 1 in 4 people who take prescription drugs say they have difficulty affording them. This is a particular concern for seniors, who may need several medications to help manage chronic conditions.

Traditionally, health plans use policies such as prior authorization, quantity limits and step therapy to help ensure that expensive medications are prescribed and used safely, effectively and appropriately. Lately, insurers are looking at drugs—particularly new and costly specialty medications—in terms of what kind of value they deliver.

Following the work of organizations like the Institute for Clinical and Economic Review (ICER) helps establish value frameworks for certain drugs. In other words, ICER looks at what manufacturers charge for certain medications, how effective those medications are, and determines whether they are a good overall value.

Harvard Pilgrim has been collaborating with pharmaceutical companies on innovative outcomes-based contracts for specialty medications. Often, patients’ real-world experience with a new medication can differ from the controlled environment of a clinical trial. With an outcomes-based contract, if a certain drug fails to deliver specific results for our members, the pharmaceutical company will effectively lower its cost for that drug. We want to make sure our members get good results from high-priced medications.


There’s no doubt that this time of transformation and uncertainty in the health care field can be challenging. We must look for opportunities to partner with New Hampshire providers, members and our communities to find the best solutions to provide access to high-value, quality care for all.



FORM NO.: NH_CC6958_1117