Commonwealth Care MCO Perspective Deborah C. Enos 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 Key Success Factors Opportunities and Challenges

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

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

120 Days in 2006 Target populations identified Regulations developed Jan. JUNE OCT. 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

Lewin Group Research Commissioned 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

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

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

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)

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

Thank you