neighborhood health plan annual report 2011
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TWENTYFIVE YEARS STRONG
since 1986
2011 annual report
living the mission
serving our diverse communities
DEBORAH C. ENOSpresident and ceo
Dear Friend of Neighborhood Health Plan,
Please join me in celebrating 25 years of living our mission: a mission
that was established in 1986, when we were founded on the belief that
the underserved need and deserve access to quality health care. It is the
impetus of our growth, and our many achievements and successes.
And it is this belief that continues to defi ne our organization as we prepare
for the future.
Today, NHP is well positioned to embrace the future and meet the
challenges of national health reform efforts as they play out. Our key
tenets – coverage for traditionally underserved citizens, an emphasis
on primary care and wellness, and a commitment to reducing health
disparities – are consistent with the goals of Massachusetts health reform.
Our ability to be nimble, open, and strategic helps us focus on our
mission, with an eye toward evolving and transforming the way we
go about meeting it. We will continue to fulfi ll our mission in a “health-
reformed” future in part by further solidifying some of our most deeply
held relationships, such as those with community health centers,
government agencies, and other community partners. We will extend
our work in health equity by embracing more members, leveraging data,
and working toward eliminating disparities in health outcomes. We
will use our expertise in comprehensive care coordination and cultural
competency by reaching out to new populations. And we will seek
opportunities to align with strategic partners in new and innovative ways.
We are proud of what we have accomplished over the past 25 years.
And we are poised and already looking toward the next quarter century
of serving our diverse communities.
As always, we thank you for your continued support of NHP.
to promote the health and wellness
of our members, and to help ensure
equitable, affordable health care for
the diverse communities we serve
OUR
Neighborhood Health Plan, more than any other, understands the
vulnerability of our patient population and the value that community
health centers bring to the table.
Throughout its 25 years, it’s fair to say that NHP truly “lives the mission.”
For NHP, mission is about far more than an assortment of health insurance
products for low- and middle-income people. Mission is about expanding
access to high quality, culturally responsive care through coverage options
that meet the diverse needs of its members.
NHP could not do what it does were it not for its strong partnership
with our community health centers. For health centers, this enduring
relationship comes to life in a number of ways, through programs and
opportunities that help health centers do a better job in the here and now.
For example, NHP helped Greater Lawrence Family Health Center
improve our physical plant to accommodate members with disabilities by
providing grant funding to install mounted slings over exam room tables
and automatic door openers at our entrances.
To help health centers recruit and retain primary care clinicians, NHP
contributed to a loan repayment plan. To improve staff skills, NHP
offered programs in domestic violence and how to detect it among
health center patients. NHP created pay-for-performance programs to
help health centers understand benchmarks and use data to improve the
quality of their care. Right now, NHP is implementing a pilot program for
health centers to improve coordination of medical care for patients with
behavioral health problems.
Compared to other health plans, NHP may be relatively small. But its size
is also an asset, enabling it to be agile and innovative – to assess what’s
needed and do something about it in a creative and practical way.
As a health center CEO, I’m grateful for NHP’s collaboration and
partnership. As chair of the NHP board, I’m proud to be a part of an
organization that so deeply understands the vulnerability of our patients
and seeks innovative solutions to improving their health and their lives.
ROBERT J. INGALAchair, nhp board of directorsceo, greater lawrence family health center
If the axiom “the past is prelude to the future” is true, Neighborhood
Health Plan will be helping medically underserved Massachusetts
residents well into the 21st century.
NHP has an interesting past. Its roots were part of proposed Medicaid
cost containment measures put forth by Governor Edward King, who
served Massachusetts from 1979–83. King believed that enrolling all
Medicaid recipients in managed care organizations (which themselves
were relatively new) would save state dollars. While that plan did not go
forward, in the mid-1980s the US Department of Labor was offering
grants to fund studies of managed care programs for underserved
populations. The Health Action Forum of Boston and the Massachusetts
League of Community Health Centers applied for and received a grant,
and NHP was born. Its fi rst members were the more than 6,000 free
care patients seen at Boston City Hospital.
NHP began as an experiment and continued to invent new approaches
to serving the underserved – expansion into Rhode Island, affi liation
and subsequent de-affi liation with then-Harvard Community Health
Plan, work with state government to embrace Commonwealth Choice
and Commonwealth Care, and many more. Throughout its history – in
periods of fi scal restraint and substantial growth – NHP has never lost
sight of either its key customer (the medically underserved) or its key
partner (the state’s 52 community health center organizations).
Now, in anticipation of national health care reform, others around the
country are trying to replicate this model of a constantly evolving
managed care organization that bridges different economic strata while
remaining true to its community roots. And whether identifi ed in the
future as an “accountable care organization” or “integrated care
organization,” NHP and its community health center members are
ready to respond.
JAMES W. HUNT, JR.president and ceomassachusetts league of community health centers
thre
e
LIVES
How do we improve access to carefor vulnerable populations?
By successfully collaborating and partnering with
community health centers, community-responsive
providers and organizations, and government agen-
cies to remove cultural, fi nancial, and physical barriers
that impede access to care. We consistently seek to
improve the quality of care provided so that vulnerable
populations not only have access to care, but access
to some of the highest quality care in the nation.
we were the fi rst safety net health plan to offer members a continuum of coverage across all products
Changing Lives with Access to Coverage
Access to care is a founding principle of
Neighborhood Health Plan. With the passage of
the Massachusetts health care reform law in 2006,
we had an unprecedented opportunity to help
even more medically underserved residents attain
much needed health insurance. The advent of
this law helped to transform our organization as
well as the lives of previously uninsured and
underinsured residents who now have affordable,
accessible, high-quality health insurance and
care, with both government-funded and commer-
cially insured products to help meet their needs.
Working side by side with state government,
health care advocates, providers, and other health
plans, NHP was actively involved in the planning
and implementation of the Commonwealth’s
landmark health care reform law. We were the
fi rst safety net health plan to offer members a
continuum of coverage across all product lines:
• MassHealth (Medicaid);
• Commonwealth Care (subsidized care for those
who do not qualify for Medicaid);
• and Commercial Insurance, including Common-
wealth Choice (offered through the Connector
for individuals and small businesses who
previously could not afford health insurance).
These offerings allow our members to remain
covered regardless of their economic status and
provide them with continuity of care as their
income status changes.
Since 2006, we have nearly doubled our overall
membership to 245,000 – enrolling more than
100,000 residents into one of our products – and
offering access to coverage, benefi ts, and care
coordination services that were previously out
of reach for certain populations.
five
we employ a holistic approach to care that supports our mission, and our members’ needs
OURPROMISE
How do we ensure we care for the whole patient?
In 1998, NHP developed its Social Care Management
Program. Our team of social care managers collaborate
with medical and behavioral health care managers
to help hundreds of members meet their basic needs,
such as determining program eligibility for public
assistance/cash benefi ts; housing services; food
programs; or services for people with disabilities.
They organize transportation to help members make
their medical appointments, provide phone numbers,
help with placing calls and fi lling out applications,
and write referrals as needed.
Serving members’ medical and behavioral health
care needs is standard operating procedure for
a health plan. However, we believe that our
responsibility goes deeper, particularly for those
with complex medical conditions who often face
socially challenging situations. We employ a
holistic care approach to care that supports our
mission, and our members’ needs.
Neighborhood Health Plan’s Care Management
Program is an integrated model of care manage-
ment that focuses on the medical, behavioral, and
social needs of members. It is specially designed
to help primary care and other care providers offer
appropriate, accessible, and cost-effective care for
NHP members with a severe or chronic illness or
condition. NHP care managers possess clinical
expertise in a multitude of settings and specialties,
including asthma, diabetes, rehabilitation, pediat-
rics, and perinatal care, and are closely aligned
with primary care sites. They work directly with
members that have complex health care needs to
develop care management plans, involving and
coordinating input from members and multiple
health care disciplines. Our goals include patient
education, ensuring adherence to medical care
plans and medication regimens, promoting
healthy self-care practices, and the empowerment
of members to advocate for themselves and to
navigate the health care system effectively.
Additionally, we employ interventions that include
assisting members with benefi ts, and help in
gaining access to care services, community
resources, entitlement programs, health care
alternatives, and other needed services.
This integrated approach helps ensure high
quality care for those who need it most, and
exemplifies how we work across the care
continuum to improve members’ health
and well-being.
Serving Members’ Needs
seve
n
OUR
IN CARE
By knowing who they are and what they need. Our
community roots run broad and deep. Each day, we
work in a culturally sensitive manner with traditionally
underserved populations, and we identify and em-
brace new ones as communities grow and evolve.
community health centers offer quality primary, preventive, and dental care, as well as mental health, substance abuse, and many other community-based services
How do we best serve the underserved?
eigh
t
Our Partners
Since its founding, Neighborhood Health Plan has
been a community health center-based HMO – the
only one of its kind in Massachusetts. Community
health centers remain our primary care foundation,
and our mission is integral to supporting the
mis sions of the 52 community health center
organizations throughout Massachusetts.
Community health centers offer quality primary,
preventive, and dental care, as well as mental
health, substance abuse, and many other commu-
nity-based services. Collectively, they care for one
in nine Massachusetts residents and are a major
source of care for the medically underserved.
Their patients are disproportionately low-income,
publicly insured or uninsured, and are also at
higher risk for chronic and complex diseases.
We have established – and maintain – close partner-
ships and relationships with community health
centers, including fi nancial support, technology,
and human resources for traditional and innovative
programs. This support helps ensure that commu-
nity health centers strengthen and grow to
provide for the evolving needs of the populations
they serve.
Over time, we have also expanded our network
to include a number of community-responsive
providers and hospitals across the state that share
our commitment to coordinated, patient-centered
care and can support the increasing needs of our
growing membership base.
Working together, these organizations are our
strategic allies and trusted partners in quality
care delivery.
OUR
ACHIEVING HEALTH EQUITY
How do we work to eliminate health disparities?
NHP found that Black/African-American women
members were receiving mammograms to screen
for breast cancer less often than White, Hispanic,
or Asian members. In response, we developed
an integrated campaign targeting this population,
particularly those living in socio-economically
disadvantaged communities. Developing information
to help remove barriers to care, we strategically
placed advertising, posters, and pamphlets throughout
the community, launched a mammography hotline
to help direct women to care, conducted multilingual
phone-a-thons in partnership with YWCA Boston,
and collaborated with Dana-Farber Cancer Institute’s
mobile mammography van. The disparity gap was
closed in 18 months.
Health equity – the absence of health differences
between racial and ethnic groups – is at the
heart of Neighborhood Health Plan’s mission.
Ultimately, achieving health equity ensures that
everyone receives the same level and quality of
care, whether that care is subsidized or privately
insured. It is not only an integral aspect of our
mission; it is a hallmark of our organization.
Health equity requires that the health status of
racial, ethnic, and linguistic minority populations
and other underserved groups – who are often
less healthy overall than majority populations –
be identifi ed and measured, and solutions found
to lessen gaps in health status.
Many factors contribute to health inequalities, such
as lower income and education levels, lack of access
to care, and language barriers. Health inequalities
are also found among racial and ethnic groups.1
Our ability to improve quality and ensure health
equity for our members depends in part on how
well we know our members and are connected to
the communities in which they live.
In 2007, NHP began tracking member self-reported
Achieving Health Equity
OUR
ACHIEVING HEALTH EQUITYrace and ethnicity data. Our goal was to use
this data along with nationally-accepted quality
metrics to identify gaps in care. We utilize this
information to create targeted programs aimed at
improving health outcomes for NHP’s vulnerable
populations and, at the same time, help both
members and communities remain healthier.
Today, NHP has this data on 60 percent of our
membership, and we are recognized as a national
leader in collecting and analyzing race and ethnic-
ity data for health equity purposes and using the
information to create awareness campaigns to
reach the intended audience.
To date, programs we have developed to address
discovered inequities in care have succeeded in
mitigating gaps found in diabetic care for Hispanics,
and breast cancer screening rates for Black and
African-American women.
1 Commission to End Racial & Ethnic Health Disparities Report, August 2007. The Massachusetts Department of Public Health reports that, overall, Black and Hispanic adults are in poorer health than white adults; Blacks and Hispanics face higher rates of diabetes than whites; and some racial and ethnic groups are at higher risk for death from diabetes, asthma, cancer, and HIV.
elev
en
We are partners committed to building
and fostering relationships that promote the
health and wellness of our members as well
as the communities we serve and live in.
For Neighborhood Health Plan, the idea of
community is central to our mission and broadly
defi ned. There are countless examples, and
below are just a few that illustrate this, such as:
• preparing nutrition information for Muslim
families about staying healthy while fasting;
• delivering culturally sensitive care programs
and teaching materials to Hispanic members for
chronic conditions such as asthma and diabetes;
• conducting outreach to Black and African-
American women through annual breast health
phone-a-thons with YWCA Boston;
• helping members secure basic social needs
such as housing, food, clothing, or utilities;
• and providing call center interpreter services
in over 150 languages.
NHP is More than a Health Plan
How do we demonstrate our commitment to diversity?
By “walking the talk” of diversity and cultural competence.
NHP members represent a broad spectrum of racial,
ethnic, and cultural diversity in Massachusetts.
And so do its employees, who closely mirror NHP’s
membership. Our commitment to diversity in staffi ng
provides an advantage toward being culturally aware
of members and working with them in a way they
understand and feel at ease with.
Through each encounter, our employees reinforce
our promise to build and maintain the important
relationships we have with members, providers, and
partners in care that together serve communities
across Massachusetts. These relationships are at the
heart of the work that we as an organization strive
to excel at each day. The pride our employees have
in their work and their passion for serving the
underserved refl ect the mission and values on
which our organization was founded. So too, we
strive to provide our employees with opportunities
to not only serve communities through their every
day job responsibilities, but also through opportu-
nities to actively participate in NHP’s Diversity
Committee, our Domestic Violence Task Force,
and numerous volunteer events conducted with
community partners such as the American Heart
Association, Cradles to Crayons, and others.
we are partners committed to building and fostering relationships that promote the health and wellness of our members as well as the communities we serve and live in th
irtee
n
A Constant Driver
Through all our efforts in assuring access to
care, developing and leveraging relationships,
integrating care services, and mitigating health
disparities, there is a constant driver: our
commitment to quality. Quality of care delivered
through our provider network is at the core of
all aspects of our key tenets, from ensuring
that low-income members receive the same
high-quality care that Commercial members
do to working with information technology
specialists to develop prenatal predictors for
high-risk births to addressing medical, behavioral,
and social barriers for people with diabetes
and hypertension through group medical visits.
quality of care delivered through our provider network is at the core of all aspects of our key tenets
Neighborhood Health Plan earned and continues
to maintain an accreditation status of “Excellent”
from the National Committee for Quality Assurance2
(NCQA) for both its Medicaid and Commercial
products. In addition, for a fourth straight year,
NHP was ranked by NCQA as one of the top fi ve
Medicaid plans in the country. These scores are
based on rigorous and comprehensive quality
performance reviews conducted by NCQA and
refl ect member satisfaction and success in
preventing and treating illness.
2 The National Committee for Quality Assurance (NCQA) is an independent, nonprofit organization that assesses and reports on the quality of the nation's health plans.
four
teen
TO QUALITY
How do we ensure quality?
One way is by ensuring quality care is delivered to
those who truly need it most. The Special Kids-Special
Care program, created with the Department of Social
Services (DSS) and the Division of Medical Assis-
tance and managed exclusively through NHP, assures
medically complex children in the custody of the DSS
and living in foster homes have access to high-quality,
well-coordinated health care services.
Each child in this program has their own primary care
provider and nurse practitioner who work with the
child’s pediatrician, foster family, case workers, and
other specialty providers to ensure the child receives
the best care possible, including the full range of
services and equipment needed. The program’s out-
reach philosophy ensures that the nurse practitioner
works with the child wherever they need help – in the
foster home, at school, or a physician’s offi ce – and
includes all stakeholders in the child’s care.
we are positioning neighborhood health plan to be a strong and sustainable health care organization for many years to come
Looking Ahead
How do we position ourselves for the future?
One way is leading by example. A marker of an
organization’s leadership status is the recognition its
company and staff receives. Recently, Neighborhood
Health Plan has been recognized by:
• The Boston Business Journal (BBJ) named Deborah
Enos, president and CEO of Neighborhood Health
Plan, and the company itself as 2010 Leaders
in Diversity. NHP was the only organization to be
honored in both categories.
• The Environmental Protection Agency awarded
NHP’s Asthma Disease Management Program,
led by Dr. James Glauber, with the 2010 National
Leadership Award for Asthma Management.
• The BBJ honored CMO Paul Mendis, MD, as a 2011
Champion in Health Care for Community Outreach.
• The National Association for Community Affi liated
Plans presented its 2011 “Making a Difference”
award to William Sweet, NHP pediatric nurse prac-
titioner and complex care management coordinator,
in recognition of his outstanding service to under-
served children with disabilities and their families.
• The AdClub of Boston distinguished NHP with a
2011 Rosoff Award for ‘Marketing to a Diverse
Audience’ with its successful breast cancer
screening communications campaign targeted
to Black and African-American women.
As we look to the future and the challenges ahead,
we are positioning Neighborhood Health Plan to be
a strong and sustainable health care organization
for many years to come. As the health care land-
scape shifts and organizations position themselves
for the new world of integrated care organizations,
we are poised to ensure that our mission of serving
the underserved together with community health
centers and other community-responsive providers
continues and grows. As the nation wrestles
with how to provide coverage for the millions of
uninsured and do so in a way that ensures quality
affordable care, we have set a positive example.
Challenges confront health care at every turn, but
we are confi dent in our ability to weather the cross
currents and emerge stronger and better able in
continuing to fulfi ll our mission.
seve
ntee
n
TWENTY FIVE YEARSTWENTY FIVE YEARS
STRONG
TWENTY FIVE YEARS
CHANGING LIVES
KEEPING PROMISES
FORGING PARTNERSHIPS
ACHIEVING HEALTH EQUITY
CONNECTING WITH COMMUNITIES
COMMITTING TO QUALITY
BUILDING FOR THE FUTURETWENTY FIVE YEARS BUILDING FOR THE FUTUREBUILDING FOR THE FUTURE
STRONG
NEIGHBORHOOD HEALTH PLAN, INC. & SUBSIDIARY2011 CONSOLIDATED BALANCE SHEET
twen
ty
BALANCESHEET
REVENUE & EXPENSE STATEMENT
As of December 31, 2011 and 2010
For the years ended December 31, 2011 and 2010
dollars in thousands
dollars in thousands
2011* 2010
Total Member Months 2,845,044 2,542,251
Total Revenue $ 1,228,794 $ 1,054,412
Total Medical Expense 1,147,237 977,017
Total G & A Expense 81,433 72,797
Total Operating Expense 1,228,670 1,049,814
Total Operating Income 124 4,598
Net Investment Income 3,629 6,107
Net Income $ 3,753 $ 10,705
2011* 2010
Assets
Total Cash & Investments $ 233,604 $ 253,236
Receivable & Other 54,621 50,000
Total Current Assets 288,225 303,236
Net Fixed Assets & Other 5,244 6,126
Total Assets $ 293,469 $ 309,362
Liabilities
Medical, Hospital & Rx Payables $ 120,113 $ 122,314
Defi ciency Reserve / MLR 13,105 14,541
Other Current Liabilities 11,599 26,179
Total Current Liabilities 144,817 163,034
Note Payable - Long Term 10,000 10,000
Deferred Lease Liability 1,724 2,137
Total Liabilities 156,541 175,171
Total Net Assets 136,928 134,191
Total Liabilities & Net Assets $ 293,469 $ 309,362
*Unaudited as of 3/31/12
253 summer street, boston ma 02210 | nhp.org
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