In partnership with Harvard Pilgrim Health Care, Northeastern University's D'Amore-McKim School of Business created a custom executive education program that applies business intelligence and analytic concepts to strengthen the performance capabilities of a health plan.
Harvard Pilgrim Health Care is a Massachusetts-based, 1,200-person health benefits organization with a network of more than 135 hospitals and 28,000 doctors and clinicians. It sought a partner that would provide highly relevant and actionable educational content focused on real business needs.
The opportunity
Faced with the industry challenges driven by healthcare reform, the evolving demands of its employer and provider networks, and competitive pressures in the healthcare industry, Harvard Pilgrim identified a need to strengthen its business intelligence and analytic capabilities to enhance its competitive position and address market forces affecting its business.
The solution
In partnership with the executive education program at Northeastern University's D'Amore-McKim School of Business, Harvard Pilgrim developed and delivered a business intelligence and analytics education and training program. Targeted at senior managers and directors from IT, finance, and medical services, the program was designed to address several issues, most notably Harvard Pilgrim's evolving relationship with its provider network from a fee-for-service arrangement to a more collaborative, shared risk arrangement.
Harvard Pilgrim partnered with Northeastern because it is a university recognized for combining cutting-edge research with applied, experiential learning. Northeastern's immersive business cooperative education program is consistently ranked number one in the country, and the university was able to draw on faculty with academic and industry backgrounds in business, healthcare systems, healthcare informatics, and quality measurement and evaluation.
The process
One of the first—and most important—steps to developing the program involved in-depth faculty interviews with Harvard Pilgrim executives from various departments. The interviews included Harvard Pilgrim's chief medical officer, chief information officer, senior vice president for network management, and vice president of clinical programs and operations. The executives shared their perspectives and insights on market challenges and opportunities, specific organizational needs, and partner and customer concerns.
The purpose of these interviews was twofold—to involve the executives in the process because their buy-in was considered a critical success factor for this initiative, and to obtain insights from the executives about the key content areas around which to focus the program.
Following the interviews, Northeastern and Harvard Pilgrim held a series of design sessions during the course of several months. The team used the sessions to map the program format and content to best meet the learning objectives set forth by Harvard Pilgrim. Program design was driven by a variety of factors.
Employer and provider demands. As the healthcare industry continues to evolve, employers are demanding a greater focus on measuring quality of care, including health outcomes, and providers are increasingly adopting new business models that call for coordinated care and shared financial risk arrangements.
Value creation through informatics. Responding to new competitive challenges requires that health plans create and capture value through informatics directed at improving health outcomes and supporting value-based provider networks that engage consumers in making informed healthcare decisions.
Differentiation. Creating and capturing value through informatics should serve as a competitive differentiator and a cornerstone to changing Harvard Pilgrim's relationship with its provider network.
Collaboration with employers and providers. Innovative approaches for collaborating with employers and providers are critical to the success of these efforts. Such collaboration involves helping stakeholders navigate industry changes and take advantage of market opportunities.
Internal collaboration. Collaborating across organizational units within Harvard Pilgrim—to leverage expertise and resources, frame and reframe problems, gather and integrate data, and measure and track performance—also is critical for success.
Additionally, the program team identified four important program requirements:
- Market focus—addressing current market conditions and trends, evolving stakeholder expectations, and the subsequent implications for the future of the business.
- Frameworks and concepts—introducing frameworks and concepts focused on quality of care, performance measurement, analytics, and internal and external collaboration.
- Business projects—the practical application of learning through business projects focused on real business issues within Harvard Pilgrim.
- Executive involvement—collaborating with senior leaders to identify and shape program content and the business projects to focus on throughout the program.
With these requirements in mind, Northeastern's faculty developed the curriculum and teaching materials, which included case illustrations, presentations conveying concepts and frameworks, suggested readings, and exercises to reinforce concepts and analytic methods. They also worked closely with Harvard Pilgrim to develop team projects tied to the organization's business needs.
Program format
Twenty-three employees representing senior managers and directors from IT, finance, and medical services participated in the initial program offering, implemented during a three-week period with classroom sessions running one full day each week. This format allowed for executive involvement and group work between the formal sessions.
To adequately address the unique needs of this cross-functional group, the curriculum had to balance both core and high-level content because portions of the content were more familiar to some than others. The concepts introduced focused on quality of care, performance measurement, and analytics.
During class sessions, participants had time to work on projects, and project teams met on their own during or after work hours to complete their work. Northeastern faculty members provided project teams with guidance and coaching throughout the course of the program.
At the conclusion of the three-week program, each team presented its project to a review panel comprised of Harvard Pilgrim executives who provided comments and feedback and offered considerations for moving the projects forward.
Results and lessons learned
The program resulted in four pilot projects designed to help meet challenges identified by Harvard Pilgrim's senior leaders.
- Medical home model—develops the intelligence and analytic capabilities for implementing the medical home model for chronic high-cost patients.
- Orthopedic factory pilot—develops the intelligence and analytic capabilities for implementing an orthopedic factory pilot.
- Small group practices—develops the intelligence and analytic capabilities for assisting small primary care group practices operating under shared financial risk arrangements to determine which specialty providers offer cost-effective care.
- Dashboard—develops a performance dashboard to assist Harvard Pilgrim leadership to monitor and evaluate the success of the aforementioned pilots.
The organization is incorporating each project within its ongoing work. Additionally, and perhaps most important, the program provided participants with tools, insights, and a common language for working cross-functionally to frame and reframe business problems and solutions on an ongoing basis.
One participant describes his experience: "Rarely do I learn as much in an entire year as I learned in these ... sessions." According to another, "One of the most valuable aspects was being in the room with people from so many different areas."
Due to the success of the initial business intelligence and analytics offering, Northeastern and Harvard Pilgrim are collaborating on future iterations of the program, which include the potential for using virtual delivery formats to reach a broader audience.
As the program team navigates its way forward, it will keep in mind several critical success factors: high levels of executive involvement throughout the process; a pedagogy that combines cutting-edge research with applied, experiential learning; a faculty team with relevant and cross-disciplinary experience; and cross-functional participation. These factors create an effective and valuable executive education program with the potential to serve as a model for any organization facing similar challenges.