This morning, U.S. News & World Report and the National Committee for Quality Assurance released their third annual “America’s best health plans” list*. Harvard Pilgrim, for the third year in a row, finished first in the country. Three surveys — three #1 finishes. Pretty cool.

Every health plan takes a lot of heat about what’s wrong with health care. Some of the time, we deserve it. I hope we acknowledge our mistakes, try to correct them, and try not to repeat them. And I know we spend a lot of time on getting the small stuff right — because it’s often the small stuff that makes people nuts. But sometimes, we get the big things right, too. Take “Frank.” He was an older, but apparently healthy Harvard Pilgrim member who was admitted to Lowell General Hospital last August with weakness, inability to eat and severe pain. Tragically, he was diagnosed with advanced esophageal cancer that had spread throughout his body. He had delayed seeking treatment for his symptoms because he was busy being the primary caregiver for his blind and disabled wife. This diagnosis shocked him and his family, and made the “what now” process difficult — to say the least. Harvard Pilgrim care managers worked closely with the family and with hospital staff to facilitate a discharge plan to a skilled nursing facility where “Frank” could learn to manage his symptoms in hopes of returning home to his wife. Soon after being transferred there, we learned that “Frank’s” unit would be closing and he would need to be discharged.

Understanding that he couldn’t go home safely and manage his illness or care for his wife, we started working with his daughter to locate another skilled nursing facility close to his home that would meet his current and future needs. He was moved to a skilled nursing facility where his family was able to spend time with him. We then helped him and his family think about other options, including hospice care. This option made it possible for him to stay close to his family without having to change facilities. His family described the skilled nursing facility as “the next best place to home.” When he passed away, he did so with his family by his side.

This is a sad story, to be sure, but it also represents one way in which health plans can make a positive difference. We aren’t perfect, and don’t pretend to be. But we do know a fair amount about the “system,” and try to help our members use it in whatever way makes the most sense for them.

Kudos to U.S. News & World Report for acknowledging that some health plans do try to do the right thing.

* America’s Best Health Plans is a trademark of U.S. News & World Report.

Posted by Charlie Baker in Care Management, Harvard Pilgrim