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Organization Name and
Address:
Neighborhood Health Plan
253 Summer Street
Boston, MA 02210 |
Contact name:
Sonia Javier-Obinger
Contact e-mail:
sjavier@nhp.org
Chief Medical
Officer:
Paul Mendis |
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Phone / fax:
(617) 772-5500
Fax: (617) 772-5513 |
CEO:
Deborah Enos |
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Web site:
http://www.nhp.org |
COO:
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Years Operational:
20 |
CFO:
Harold Putnam |
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Enrollment level, by
payer:
106,000 - Medicaid, AFDC (all MassHealth members except for Basic and
CMA program members)
22,436- other Commercial
128,436 - Total (as of 1/2006) |
Percent of enrollment
served by CHC clinics:
60% served by CHC sites
40% served by all other sites
Corporate status:
Non-profit, taxable (income tax exempt), state- licensed Health Care
Service Contractor
Certifications (JACHO,
NCQA, HMO):
HMO |
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Governance:
NHP's board consists of 11 directors, five league directors (selected
by the Massachusetts League of Community Health Centers), the
president of the corporation, the president of the Mass. League and
four at-large directors. |
Reserve requirements:
45 day's premium for Medicaid population |
Network description:
Neighborhood Health Plan's provider network includes 1,800
primary care physicians on staff at more than 225 primary care
sites, 9,000 specialists and 41 teaching and community hospitals
in Massachusetts. Our members also have access to a large
behavioral health (mental health and substance abuse) provider
network through Beacon Health Strategies, our behavioral health
subcontractor.
Pharmacy benefit and management:
Pharmacy Benefits Manager (PBM), MEDMETRICS, Open
Formulary, generic usage: 55%
TPA/Information systems:
NHP manages and administers all of its own information systems,
including membership and clinical services, with the exception
of its electronic claims processing system, which is managed by
TXEN, per a remote computing arrangement.
History of the organization:
Neighborhood Health Plan (NHP), a not-for-profit health
maintenance organization (HMO), was founded by the Massachusetts
League of Community Health Centers and the Greater Boston Forum
for Health Action in 1986. NHP was licensed as an HMO by the
Massachusetts Division of Insurance in November 1987. In
partnership with community health centers and other
community-responsive providers, NHP develops and operates
cooperative managed care systems which are member focused,
quality driven, community based, culturally responsive and
financially viable in contemporary and future health care
environments.
Four major challenges the organization faces during 2006:
· Assuring financial stability while providing quality,
cost-effective health care to our members
Providing access to high quality healthcare to our members
· Developing clinical initiatives to enhance the health care of
our members and the public
· Implementing medical management programs to serve the needs of
special populations |
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| Last Updated: January 2006 |
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