1. 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

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*: ,000
Commonwealth Care*: ,000
Commercial/CommChoice: ,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. Massachusetts Health Care Reform Commonwealth Care Health Insurance Program (CCHIP)
The 120-Day Launch

5. 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

6. 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

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