Michael Carson is the Chief Business Growth Officer for Harvard Pilgrim Health Care. Serving as Chief Business Growth Officer since January 2017, Michael is responsible for Harvard Pilgrim’s Commercial and Government Program business segments across its markets including Massachusetts, New Hampshire, Maine and Connecticut. He is also responsible for the organizations’ Corporate Health Services, Pharmacy, Health Care Analytics, Network, Sales & Marketing and Product Development functions.
Michael joined Harvard Pilgrim from ConcertoHealth, a multi-state, risk contracting, PCP and MSO-model medical group based in Irvine, CA where he served as Chief Operating Officer responsible for care delivery, clinical operations, growth and Health Plan delegated Utilization, Care, Quality and Revenue Management functions.
Prior to ConcertoHealth, Michael served as President of Anthem’s Eastern Region Medicare business based in New York City with responsibility for a multi-product portfolio and eight Health Plans from Maine to Florida. Michael has also held key leadership positions with Amerigroup based in Virginia, Premera Blue Cross in Washington State and Anthem’s Western Region based in Colorado.
Michael was born and raised in Germany, is a U.S. Air Force veteran and a proud father of his University of Virginia graduated daughter Desiree. While serving our country, Michael earned his Bachelor of Science in Business Administration by attending the Universities of Maryland and Phoenix and has studied at University of Indiana’s Kelley School of Business.
What is your vision for the growth of Harvard Pilgrim?
Harvard Pilgrim Health Care (HPHC) has been serving its members and communities and providing access to affordable care since 1969. We will soon be celebrating our 50th anniversary. To accomplish this, HPHC has had to be innovative in healthcare services and delivery. We’ve had to be a healthcare partner and guide to our members, as well as provide value to our clients.
My vision for HPHC’s growth is to continue that great tradition and help our organization flourish in our next 50 years. We will do this by focusing on sustainable growth strategies, and by proactively anticipating and exceeding the needs of our customers. This means HPHC will continue to be a leader in data- and research-driven product offerings, medical cost management and clinical interventions, a leader in quality and service delivery, and a leader in embracing diversity.
We are continuously improving and evolving as an organization. In 2017 alone we introduced new products that provide flexibility based on how members use their benefits — and products to meet the unique needs of growing populations like our Millennials. We launched new digital and self-serve solutions for our customers to make it even easier to do business with us. We executed new and innovative member engagement and medical cost management initiatives to address emerging cost drivers. We established new, industry-leading, outcomes- and value-based pharmaceutical and provider contracts to ensure that our members continue to have access to affordable care.
These are just some examples of how HPHC is growing and will continue to grow. We believe we increase our value to our current customers as well as those who will be joining us in the future.
Healthcare is perceived as an industry where costs are spiraling. What framework does Harvard Pilgrim use to contain costs?
At HPHC, we take great pride in fulfilling our mission of improving the quality and value of healthcare for our members and communities. Healthcare costs can be distinctly categorized and are largely driven by Hospital, Pharmacy, Primary Care and Specialty Care costs. We use analytical strategies to identify current and emerging trends and outliers driving these costs, then deploy clinical, contractual and operational interventions to mitigate them.
These include the use of aforementioned value- and outcomes-based contracts with providers and pharmaceutical companies. They include clinical innovations such as hospital-at-home and specialty care programs as well as alternative medicine benefits. And, perhaps most importantly, they include member engagement and care coordination interventions to determine the right care needed, in the right setting and at the right time, to ensure the best health outcome for the member at the most appropriate cost. We do this from a whole-person health perspective, because it’s important to consider medical, behavioral and social components when helping our members navigate through the healthcare system to achieve their best health. We consider ourselves guides in this process., and anally for our members and their families.
Why should small and medium scale businesses choose Harvard Pilgrim as the insurance of choice for their employees?
HPHC is large enough to make a difference and small enough to pay attention. As a recognized, national leader in healthcare services, quality and innovation with a 50-year commitment to serving New England communities, we’re an insurance partner that our clients are proud to offer to their employees. We’re a local, not-for-profit health services company with the capabilities of and access to local and national provider networks, a leader in diversity and inclusion, and a leader in quality and service. In fact, we’ve been recognized as a Great Place to Work for 15 straight years. This is a testament to all the employees who make HPHC a great place to work, and who are dedicated to serving our members and clients.
Specifically, HPHC serves thousands of small and medium-sized businesses throughout New England and across the country. We recognize the important role that small and medium-sized businesses play in our communities, and we understand how important affordable healthcare options and transparency are to them. Wealso understand that every client is unique. We listen to their needs and offer unique options, such as our travel benefit, which allows for short-term policies covering visiting family members. Our objective is to be our clients’ trusted healthcare partner, and we seek to offer solutions to meet their needs…regardless of how big or small the client.
How well used is Harvard Pilgrim's Eastern Harmony program?
Complementary and integrative therapies are here and growing. Many hospitals are now offering these therapies. Health maintenance organizations (HMOs) are covering them. A growing number of physicians are using them in their practices. Insurance coverage for them is increasing. And integrative medicine centers and clinics are being established, many with close ties to medical schools and teaching hospitals.
Eastern Harmony, which offers complementary and integrative medicine, has been a great differentiator for HPHC in many communities we serve. We find that the largest utilization of integrative medicine by our members is acupuncture, which we made a benefit for our fully insured plans in 2015. We have received very positive responses since we implemented this benefit. For example, a nurse at Harvard Pilgrim Health Care shared how she used acupuncture to quit smoking after 40 years of smoking.
Do you see Eastern Harmony having an impact on cost containment?
Research has proven that Integrative Medicine places greater emphasis on prevention and wellness, and can not only reduce costs, but also improve outcomes and quality. Research has also demonstrated the clinical effectiveness of many Integrative Medicine interventions. And recent studies have shown that Integrative Medicine is cost-effective. For these reasons, we are seeking opportunities in the future to track member utilization of the acupuncture benefit to measure outcomes and cost effectiveness.
What special programs do you provide for visitors?
Harvard Pilgrim Health Care has partnered with International Medical Group (IMG) to offer urgent/emergency coverage to non-citizens who are coming to the U.S. to visit family and friends. This benefit resulted from feedback from our SA Indian business and community partners in collaboration with our Center for Inclusion. It has proven to be a valuable differentiator for us, and a value add to our Eastern Harmony offering.
Any special message for our readers?
Healthcare is local. Healthcare is community. Healthcare is family. Healthcare is you. Harvard Pilgrim Health Care is here for you and your family. We’re dedicated to offering not just affordable access to quality care in your community, but also solutions that are as unique as you are. Whether it’s Harvard Pilgrim as your insurance company or the Harvard Pilgrim Foundation there to make our communities better, HPHC is proud to be part of your community.
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