Harvard Pilgrim Health Care and Tufts Health Plan

Bringing together the best of both of your great organizations, plus the national expertise we lend across the health services space, would be one powerful combination. We are a strategic pharmacy partner who will take your growth and retention goals as seriously as you do, and continually innovate to improve health and financial outcomes for your members and clients.

Thank you for the opportunity to continue exploring how we can take our combined strengths to new heights. Click below to access the materials from our recent meeting.
NewCo
We look forward to working with the NewCo team
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John Wigneswaran, MD
Chief Medical Officer and Executive Sponsor
I’m looking forward to getting to know the Tufts and Harvard Pilgrim teams and collaborating with you as you bring your organizations together. I’m a Boston resident, attended medical school at Tufts University and have lived in the New England area for most of my life. I'm hoping we can be the partner you need, and serve as a strategic, flexible and service-oriented pharmacy and health services partner who thinks ahead and is ready to take on your toughest challenges. We truly care about patients first and foremost, and would be honored to be your partner.

Go-to-market SWAT team

Our research shows a tremendous opportunity for NewCo to grow in your market and mitigate carve outs. A partnership with Express Scripts comes with a dedicated market development team, and $1 million development fund, with the single focus of helping you achieve your growth goals.

This team will partner with NewCo to design a custom, 360-degree strategy for helping you win and increase your footprint across your commercial business.
Todd chan
Todd Chan
Director, Market Development, Health Plans
Brian Old
Brian Old
Director, Market Development, Health Plans
Chris Hespe
Chris Hespe
Director, Market Development, Health Plans
Corey Graves
Corey Graves
Senior Marketing Manager

Building a winning pharmacy go-to-market team

We support your value proposition that an integrated medical and pharmacy benefit substantially reduces total cost of care and improves member health when compared to carving out pharmacy benefits. How can you realize the full potential of this story to reach your plan’s growth initiatives? It all comes down to effectively managing your sales, finance and cross-functional teams, and their understanding of the importance of pharmacy is essential to fully conveying your unique value proposition.
60% 60%
of plans say they do not have the pharmacy resources or support personnel needed to meet their growth goals1
$30M $30M
revenue realized by a client after the first year of working with our market development team to optimize their pharmacy go-to-market team
15K 15K
lives carved-in for a client who secured their first pharmacy-only win after forming a pharmacy sales team including new sales, account management and broker relations
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What it takes to win
Winning doesn't happen by accident. Applying nearly a decade's worth of data and sales expertise, we've uncovered some tried and true strategies that help our health plans win and retain – and some that don't.
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Aligned in the battle against carve out
We help you tell your integrated value story. Read our latest research of the value of integration, to help ensure you have the best ammunition to tell your carve-in story and keep your edge.
Accelerate your growth strategy
Helping you win and retain your commercial clients begins with understanding your goals and the market dynamics. Working closely with your teams, we deliver market development expertise and sales support.

Medicare market analysis: Key insights and findings

We operate on a belief that insights can lead to better action, and our Medicare strategists will equip you with market analyses for growth planning and insight-driven conversations focused on enrollment trends, Star Ratings trends, competitive market benefits and other aspects. These analyses can be done at the state level, service area level, or county level to meet your needs. This market analysis is a baseline version. With more data and information about your plan, these become more detailed and deep – adding in supplemental benefits analysis, Star Ratings opportunities and more.
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58% of MAPD plans in Massachusetts offer a preferred pharmacy network
Plans with $0 premium have grown significantly year over year. With Harvard Pilgrim not having a preferred pharmacy network and less than half of Tufts MAPD having one, focusing here may afford opportunities to reinvest dollars back in the plan offering.
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<50% of Medicare eligibles in a Massachusetts county received flu shots
Multiple Massachusetts counties served by NewCo plans have opportunity from a social determinants index perspective, such as Suffolk County’s flu shot penetration rate of less than 50% of Medicare eligibles. This presents opportunity for targeted outreach to members in this county annually.
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Lowest number of formulary edits among MAPD competitors
Harvard Pilgrim has the lowest number of formulary edits of the top MAPD competitors in the counties served in Maine. Is this an opportunity to more aggressively manage utilization, or a CAHPS strategy?

Flexible clinical solutions

In 2019, we saved patients and plans nearly $50 billion through our clinical solutions. Our programs are designed to bring plan sponsors the promise of simplicity, predictability and above all, affordability. See information below on several of the solutions that may be of interest to you.
Health Connect 360
Connecting Health care
What financial and clinical outcomes are sacrificed without full integration and coordination? Explore the industry's only guaranteed clinical outcomes model.
AOM video
Protecting members and preventing abuse
Americans are now more likely to die of an accidental opioid overdose than in a motor vehicle crash. How can you make sure your members are protected?
SGRX
Making medicine work harder
See how our multi-program, value-based platform unlocks new financial value and better health outcomes.
Pharm Networks
Ensuring patient safety
See how integrated medical, pharmacy and laboratory claims data translate to improved patient health and safety.
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Jenica
Therapeutic Resource Center Nurse
I love being an Accredo nurse and teaching my patients how to use their injectable medications. I make sure each of my patients is comfortable and can administer their medication successfully.
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Marsha
National Clinical Support Center Nurse
Accredo nurses are not just there for a shift, a doctor’s visit, a hospital stay or a procedure. We’re committed to our patients through their long, complicated and advanced disease. It’s humbling when patients express how relieved they are that we are here for them 24 hours a day, 7 days a week.
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Lisa
Field Nurse
I’m grateful for the gift of being allowed into a patient’s home during one of the most vulnerable times in their life and having the opportunity to help them on so many levels. The intimate bonds we forge are priceless – an immeasurable reward for the work I do as an Accredo nurse.

Fragmented drug management strategies may be costing you

Medical drug spending is expected to increase by 33% by 2023. With specialty costs rising rapidly, you may be seeking new ways to manage spend and optimize administrative efficiencies. See how our approach to integrating medical drug management optimizes drug savings across pharmacy and medical benefits, enabling better efficiency, greater savings and improved safety.
20% 20%
of claims in the highest specialty spend categories are duplicating work within plans
50% 50%
higher specialty drug approvals vs. traditional approvals within the last 4 years2
$128B $128B
projected medical spend in 2023 – a 33% increase from $96B in 20183
Learn more
We’re committed to helping health plans grow. I look forward to continuing the conversation about how we can help your plan achieve your desired clinical and financial goals. Please reach out to me if you have any questions.
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