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TWENTY FIVE YEARS STRONG

since 1986

living the mission

serving our diverse communities

2011 annual report


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 define 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 fulfill our mission in a “healthreformed” 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.

DEBORAH C. ENOS president and ceo


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. INGALA chair, nhp board of directors ceo, greater lawrence family health center


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 first 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, affiliation and subsequent de-affiliation 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 fiscal 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 identified 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 ceo massachusetts league of community health centers

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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.


How do we improve access to care for vulnerable populations? By successfully collaborating and partnering with community health centers, community-responsive providers and organizations, and government agencies to remove cultural, financial, 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.

LIVES


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 commercially 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 Commonwealth 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, benefits, and care coordination services that were previously out of reach for certain populations.

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we were the first safety net health plan to offer members a continuum of coverage across all products


we employ a holistic approach to care that supports our mission, and our members’ needs


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 benefits; 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 filling out applications, and write referrals as needed.

OUR PROMISE Serving Members’ Needs 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 management 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, pediatrics, 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 benefits, 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.

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How do we ensure we care for the whole patient?


How do we best serve the underserved?

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OUR

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 embrace new ones as communities grow and evolve.

IN CARE community health centers offer quality primary, preventive, and dental care, as well as mental health, substance abuse, and many other community-based services


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 community-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 partnerships and relationships with community health centers, including financial support, technology, and human resources for traditional and innovative programs. This support helps ensure that community 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.


How do we work to eliminate health disparities?

OUR

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.

ACHIEVING HE Achieving Health Equity 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 identified 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


race 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 ethnicity 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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EALTH EQUITY


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 staffing provides an advantage toward being culturally aware of members and working with them in a way they understand and feel at ease with.

NHP is More than a Health Plan 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 defined. 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 AfricanAmerican 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.

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 reflect 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 opportunities 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.


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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


A Constant Driver

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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.

Neighborhood Health Plan earned and continues to maintain an accreditation status of “Excellent� from the National Committee for Quality Assurance 2 (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 five Medicaid plans in the country. These scores are based on rigorous and comprehensive quality performance reviews conducted by NCQA and reflect 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.

quality of care delivered through our provider network is at the core of all aspects of our key tenets


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 Assistance 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 outreach philosophy ensures that the nurse practitioner works with the child wherever they need help – in the foster home, at school, or a physician’s office – and includes all stakeholders in the child’s care.

TO QUALITY


we are positioning neighborhood health plan to be a strong and sustainable health care organization for many years to come


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 BBJ honored CMO Paul Mendis, MD, as a 2011 Champion in Health Care for Community Outreach. • The National Association for Community Affiliated Plans presented its 2011 “Making a Difference” award to William Sweet, NHP pediatric nurse practitioner and complex care management coordinator, in recognition of his outstanding service to underserved 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.

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• 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.

Looking Ahead 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 landscape 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 confident in our ability to weather the cross currents and emerge stronger and better able in continuing to fulfill our mission.


TWENTY FIVE YEAR

ST


ARS

CHANGING LIVES KEEPING PROMISES FORGING PARTNERSHIPS ACHIEVING HEALTH EQUITY CONNECTING WITH COMMUNITIES COMMITTING TO QUALITY

TRONG BUILDING FOR THE FUTURE


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NEIGHBORHOOD HEALTH PLAN, INC. & SUBSIDIARY 2011 CONSOLIDATED BALANCE SHEET


As of December 31, 2011 and 2010

BALANCE SHEET dollars in thousands

2011*

2010

$ 233,604

$ 253,236

54,621

50,000

288,225

303,236

5,244

6,126

Assets Total Cash & Investments Receivable & Other Total Current Assets Net Fixed Assets & Other Total Assets

$

293,469

$

309,362

Liabilities Medical, Hospital & Rx Payables

$ 120,113

$ 122,314

Deficiency 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

1,724

2,137

Total Liabilities

156,541

175,171

Total Net Assets

136,928

134,191

$ 293,469

$ 309,362

Deferred Lease Liability

Total Liabilities & Net Assets

For the years ended December 31, 2011 and 2010

REVENUE & EXPENSE STATEMENT

2011*

2010

2,845,044

2,542,251

$ 1,228,794

$ 1,054,412

1,147,237

977,017

81,433

72,797

1,228,670

1,049,814

Total Operating Income

124

4,598

Net Investment Income

3,629

6,107

Total Member Months Total Revenue

dollars in thousands

Total Medical Expense Total G & A Expense Total Operating Expense

Net Income

$

3,753

$

10,705

*Unaudited as of 3/31/12


253 summer street, boston ma 02210 | nhp.org


Neighborhood Health Plan Annual Report 2011