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Commonwealth Care

Commonwealth Care. MCO Perspective National Conference on Health Care Reform in Massachusetts Deborah C. Enos President and CEO, Neighborhood Health Plan January 22, 2010. Today’s Discussion. Commonwealth Care Implementation Medicaid MCOs’ Role and Value in Health Coverage Expansion

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Commonwealth Care

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  1. Commonwealth Care MCO Perspective National Conference on Health Care Reform in Massachusetts Deborah C. Enos President and CEO, Neighborhood Health Plan January 22, 2010

  2. Today’s Discussion • Commonwealth Care Implementation • Medicaid MCOs’ Role and Value in Health Coverage Expansion • Key Success Factors • Opportunities and Challenges

  3. NHP Overview • Fully Licensed HMO • NCQA Accredited (Medicaid and Commercial) • Serving Massachusetts Since 1986 • Over 200,000 Covered Lives • Medicaid*: 139,000 • Commonwealth Care*: 33,000 • Commercial/CommChoice: 30,000 • Over 250 Primary Care Locations (2,000+ Providers) • Community Health Centers, Physician Group Practices within Massachusetts • 62 Hospitals • 420 Employees • $900m in revenues * Public Funded

  4. The 120-Day Launch Massachusetts Health Care Reform Commonwealth Care Health Insurance Program (CCHIP)

  5. 120 Days in 2006 JUNE OCT. Jan. Dec. • Target populations identified • Regulations developed • RFRs submitted by MCOs • Development of cross-functional internal and external teams • MCO product development (including vision/dental) • Operational assessment • Provider network developed/re-contracted • Design, approval, and launching of marketing campaign

  6. Lewin Group ResearchCommissioned by the Association of Community Health Plans (ACAP) • Experience and Expertise • Low-income, higher needs clients • State and other purchasers • Safety-net provider network • Committed to quality, access, and cost-control

  7. Lewin Findings • Key characteristics to leverage: • Provider Networks • Health Plan Operations • Outreach and Enrollment

  8. Lewin Conclusions: Key to Successful Implementation • Influence Planning Process • Collaborate with State and Other Policy Makers • Extensive Evaluation • Organization Commitment / Leverage Efficiencies

  9. Commonwealth Care/Health Care Reform Opportunities/Advantages “Three Year Perspective” • Mission Compatibility(Vulnerable populations, Community Health Centers) • Membership Growth(Medicaid, Commercial, Commonwealth Care) • Addressing Unmet Needs of Population • Coverage • Care Coordination • Information and Analysis • Collaboration with State and Other Plans • Model for National Health Care Reform (lessons learned)

  10. Commonwealth Care/Health Care Reform Opportunities/Advantages “Three Year Perspective” • Cost Pressures vs. Coverage • Continuity of Coverage/Care • Impact on Safety Net Providers • Primary Care Capacity • Reliance on Government Payors • Actual vs. Projected Utilization and Costs • Variation in Risk Pools • Compatibility with National Health Reform Efforts

  11. Thank you

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