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

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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

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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

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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.

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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

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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

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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.

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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

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