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.
Explore meeting materials
NewCo
Thank you for the opportunity, NewCo
We’ve thoroughly enjoyed the time spent getting to know your team and exploring how we can support your business.
Business proposal and strategic alignment
migration and transition
Specialty
govt programs
prior authorization
Technology
legal

We're just getting started

You need – and deserve – a strategic partner who is just as invested in NewCo's success and strategic growth as you are – not just a vendor who services your pharmacy claims. We look forward to digging in further with you, to take on your toughest health care challenges together. Please click below to access the presentations shared during the finalist meeting.

Business proposal and strategic alignment
Black and pink icon of a winding path with many dots. Migration and transition
specialty icon Specialty
Government programs
Prior authorization
Technology
NewCo Executive Sponsorship Council
Express Scripts, Evernorth and Cigna value our partnership with NewCo and are committed to delivering innovation, accountability and service expertise.

Executives and senior leaders play an essential role in times of change – particularly migration and integration. That's why we are committing a comprehensive Council of leadership to NewCo.

We will champion NewCo's interests and goals from the highest levels of our organizations.
NewCo exec sponsors
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.
Capability demonstration teams
We appreciate the opportunity to share our vision for a partnership with NewCo and look forward to continuing the discussion.
NewCo - business proposal and strategic alignment
NewCo - Migration and transition
NewCo - specialty
NewCo - Govt programs
NewCo - PA
NewCo - tech
NewCo - Legal-Q&A
Account management team
Backed by your executive sponsorship council, your account management team consists of dedicated leadership, account executives, clinical account executives and account managers.

Your core team is further supported by designated subject matter experts across government programs, operations, technology and sales.
NewCo acct team 1
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NewCo acct team 3
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NewCo acct team 5
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Implementation structure
Change is never easy. That’s why Express Scripts has designed a custom implementation governance structure comprised of dedicated, seasoned team members to support NewCo throughout the process.

NewCo's satisfaction and success with the transition is of utmost importance which is why your implementation experience is guaranteed.
NewCo - implementation governance
NewCo - implementation governance

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.
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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
Powering your success
If you're like many teams we work with, your Sales team is well-versed in all things medical, but would benefit from education on pharmacy to fully leverage and convey the benefits of the benefits you offer to your customers in the pharmacy space. Learn more about our strategic approach to helping you grow, retain and win.
NewCo - Market development
Build pharmacy expertise to convey value to customers
If you're like many teams we work with, your Sales team is well-versed in all things medical, but would benefit from education on pharmacy to fully leverage and convey the benefits of the benefits you offer to your customers in the pharmacy space. Our training program, available to health plans as part of our Market Development support, provides Sales as well as cross-functional teams a solid understanding of pharmacy.
Building a winning strategy to enable clients' growth and retention
Hear from Janae McAfee of Highmark about her experience working with Express Scripts and how we partner strategically with her team to drive the plan's growth and retention goals.
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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.
Learn more
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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.
Learn more
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.
Learn more

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.
Download full Medicare Market Analysis
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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?
Government programs opportunities and insights for NewCo
NewCo’s commitment to quality is shown through your impressive Star Ratings scores. Express Scripts shares that same commitment, and sees success in Star Ratings as a key area of partnership with our clients; evidenced by our industry-leading percentage of supported MAPD lives enrolled in 4-5 Star Part D plans.
NewCo MAPD
Government programs opportunities and insights for NewCo
Tufts Health Plan is scoring higher on use of opioid metrics, while a lower score is desirable, compared to the state and national benchmarks, presenting an opportunity for NewCo. We have a track record in opioid management excellence through our two-time PBM award-winning program.
NewCo Opioids HEDIS
Government programs opportunities and insights for NewCo
Within NewCo's Exchange programs, Tufts Health Public Plan and Tufts Associated HMO Plan are trailing the QRS quality scores for Harvard Pilgrim's plans in Massachusetts, Maine and New Hampshire. Leveraging the best practices established by Harvard Pilgrim's plans along with deployment of proactive management solutions and other clinical solutions could help improve critical metrics for this class.
Newco asthma management
Your trusted partner in government programs
We're squarely focused on the quality metrics that are important to you and know that our support will help you move the needle on achieving your goals – today and in the future. Through our clinical programs, network strategy, formulary management and levers designed specifically for government programs, we want to be your partner of choice.
GP stats - NewCo
Introducing Evernorth
Meet Evernorth, which brings together game-changing capabilities in life-changing ways – including benefits management, pharmacy and medical solutions, tailored to our customers’ specific needs, innovative clinical and behavioral care, pharmacy solutions from daily prescriptions to specialized therapies, and data, analytics and insights to derive value and solutions for your organization.

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.
Learn about Health Connect 360
Watch video
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?
Learn about Advanced Opioid Management
Watch video
SGRX
Making medicine work harder
See how our multi-program, value-based platform unlocks new financial value and better health outcomes.
Learn about SafeGuardRx
Watch video
Pharm Networks
Ensuring patient safety
See how integrated medical, pharmacy and laboratory claims data translate to improved patient health and safety.
Learn about Rational Med
Experience innovation in action at The Lab
See where innovation comes to life at The Lab in Saint Louis, Missouri. Engage with our experts who are transforming health care from the inside out, and come face to face with what's possible.
Engaging differently to drive better results
Hear from Chief Physician Experience Officer, Dr. Lynne Nowak, about how we connect with providers to ensure they have the information and tools needed to provide the best care and optimized outcomes for members.
Taking on your toughest challenges with Trend Central
We provide on-demand reporting with data you need to effectively manage your pharmacy benefit program. 80+ templates can be run on demand or scheduled to run on a periodic basis, leveraging more than 250 data elements available.
Trend Central
Taking on your toughest health care challenges with ScriptVision
The ScriptVisionSM suite of solutions includes digital provider capabilities that integrate data-driven technologies, remove barriers to care and enable physicians to make better clinical and cost-effective decisions for their patients – in real time.
ScriptVision
Learn more about electronic prior authorization
Electronic Prior Authorization (ePA) returns coverage decisions instantaneously and improves efficiency for physicians. ePA seamlessly integrates within a physician’s electronic health record (EHR) or through an online web portal.
ePA
Learn more about Real-Time Prescription Benefit
Real-Time Prescription Benefit provides physicians' visibility into each patient’s drug coverage and cost details during the prescribing process within the electronic health record allowing them to prescribe clinically equivalent therapies that better align with benefit design.
Real-Time Benefit Check
Supporting your patients where they need it most
Health care needs are as individualized as the members who make up your population. For those with complex conditions, we believe the best care comes from specialists – not generalists, and our model includes centers of focused expertise, dedicated to serving them. Hear more from Brian Seiz, Senior Vice President of Specialty, on how we approach specialty differently.
Simplifying specialty for physicians
Ensuring physicians’ access to information they need for their patients’ specialty medication prescriptions is always of utmost importance, but in the face of a global pandemic, providing the tools and support they need is even more crucial. Learn how MyAccredoPatients.com is simplifying the physician experience.
Caring for patients with specialized and rare conditions
30 million Americans are living with a rare disease … almost as many as are living with diabetes. Patients living with these conditions are the sickest of the sick and the rarest of the rare. Administering treatment for these conditions is complex, requires repeated education, and can cause anxiety, which may be compounded by concern around health care benefits and financial pressures. Hear from a caregiver of an Accredo patient about her experience working with our Rare Disease TRC to care for her daughter.
Hear from our dedicated staff
Listen to an Accredo nurse explain their comprehensive process for helping specialty patients learn to live with their condition, educate and provide treatment.
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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.
Learn more about our approach to medical drug management
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.
Email Rachel Reese
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References
1. 2019 survey of Express Scripts Elevate conference attendees
2. Express Scripts book for business data
3. Research and statistics compiled from: American Hospital Association. “AHA Hospital Statistics. 2018 Edition.”; Thomson Reuters Hospital Research (Aug 2011); Analysis of American Hospital Association (AHA) Annual Survey Data, 2016, for community hospitals