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Organization Name and
Address:
Community Health Plan
of Washington
720 Olive Way, Suite 300
Seattle, WA 98101 |
Contact name:
Kris Greco, Director of Marketing and Corporate Communications
Contact e-mail:
kgreco@chpw.org
Medical Director:
Barbara Graves |
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Phone / fax:
(206) 521-8833
fax: (206) 521-8834 |
CEO:
Darnell Dent |
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Web site:
http://www.chpw.org |
COO:
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Years Operational:
10 |
CFO:
Tim Frazier |
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Enrollment level, by
payer:
114,508 Medicaid
93,025 State Basic Health Plan
2641 PEBB
As of 1/1/03 |
Percent of enrollment
served by CHC clinics:
70%
Corporate status:
Non-profit, taxable, state licensed Health Care Service Contractor
Certifications (JACHO,
NCQA, HMO):
JACHO, no.
NCQA, no.
Not an HMO. |
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Governance:
10 member board, composed of CHC Executives and Clinicians
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Reserve requirements:
State required 14.2% of annual premium revenue |
Network description:
Statewide, horizontally integrated system of 19 CHCs plus
contracts with non-CHC entities (Health Dept., RHCs, commercial
clinics, residency programs) forming a network of 250 clinic
sites throughout the state. Fee-for-service contracts with 85
hospitals. Total PCPs: 1,000+, Specialists: 6000+.
Pharmacy benefit and management:
Pharmacy Benefits Manager (PBM), Express Scripts, Restricted
Formulary, generic usage for Q4/02: 64%
TPA/Information systems:
Plan served by Adaptis, a for-profit, wholly-owned subsidiary,
Community Health Network of Washington (CHNW). CHNW is formed
by the system of CHCs who formed and own CHPW. Intranet and
Internet operational.
History of the organization:
Plan created in 1992 by state CHCs. Received Bureau ISN Grant
and CHC/state support. In 1993/94 state began mandatory, risk
plus PCCM Medicaid enrollment. State also made major expansion
of Basic Health Plan in 1994. The network of CHCs initially
subcontracted as a full risk, capitated network with Blue Cross.
By 1996, network achieved sufficient reserves (10 million) and
organizational capacity to apply for Health Care Service
Contractor license. Began operation as independent insurance
entity in 1997 with 46,000 lives. Health Center “owners” have
collective, shared risk for downside losses and Plan maintains
individual pools for “owner” upside gain which is completely
distributed to CHCs after 18 month run-out.
Three major challenges the organization faces during 2003:
1. Potential impact to state health plan programs due to
Washington State budget crisis.
2. Improving network CAHPS and HEDIS results.
3. Increasing overall enrollment in product lines |
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| Last Updated: March 2003 |
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