Harvard Pilgrim Health Care Could Drop Physicians - Brief Article - Statistical Data Included

Healthcare Financial Management, Dec, 1999

Harvard Pilgrim Health Care, Boston, Massachusetts, could drop 900 physicians from its 5,000-member network if the physicians do not form or join new, local negotiating groups. The HMO wants to disband the costly Pilgrim Independent Practice Association, which was established as a negotiating unit by the former Pilgrim Health Care HMO since it merged with Harvard Community Health Plan. Harvard Pilgrim Health Care's agreement with the group covers some of the group's losses. The group's physicians did not receive any revenue from the with-hold fund at the end of 1998 because the group did not meet financial goals. Harvard Pilgrim Health Care will pay hospital-based physicians 80 percent of the going rate for their services in the future, ending the prior withholding arrangements. The HMO also wants the group's physicians to accept higher risk.

In September, Harvard Pilgrim Health Care informed Rhode Island regulators it could not continue to subsidize operating losses incurred by its Rhode Island affiliate, Harvard Pilgrim Health Care of New England. Harvard Pilgrim Health Care is selling the affiliate. The Rhode Island Department of Business Regulation has placed Harvard Pilgrim Health Care of New England in a form of receivership.