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Organization Name and
Address:
Neighborhood Health Plan
of Rhode Island
299 Promenade Street
Providence, RI 02908 |
Contact name:
Mark Reynolds, CEO
Contact e-mail:
Chief Medical Officer:
Dr. Mack Johnston |
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Phone / fax:
401-459-6000
fax: 401-459-6175 |
CEO:
Mark Reynolds |
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Web site:
http://www.nhpri.org |
COO:
Raymond Sessler |
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Years Operational:
Ten |
CFO:
Karen Fifer Ferry |
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Enrollment level, by
payer:
Medicaid (RIte Care Program – up to 250% of poverty and no SSI) –
67,000
Commercial – 139 |
Percent of enrollment
served by CHC clinics:
47%
Corporate status:
Not-For-Profit
Certifications (JACHO,
NCQA, HMO):
Licensed HMO,
NCQA Accreditation received 3/00.
“Excellent Status” awarded in 2001 |
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Governance:
15 person Board – 7 from CHCs, 1 from RI Health Center Association, 1
from RI Foundation, CEO of health plan, and five at large.
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Reserve requirements:
NAIC RBC guidelines
Legislation gives us potential exemption. |
Network description:
648 PCPs in 19 Health Center locations, 10 Hospital sites and
190 private offices,
1,3961 specialists, all hospitals in state. Carved out mental
health with Beacon Health Strategies
Pharmacy benefit and management:
Plan at full risk – uses Med-Impact PBM
TPA/Information systems:
In house system – Health Systems Design
All Decision Support/HEDIS done internally.
History of the organization:
Founded by RI CHCs with start of RIte Care.
1996 - Major Creditor converted to equity stake. Negotiated
reinsurance relationship with state to maintain financial
viability.
1997 – set up series of incentive-based reimbursements to CHCs
around ER use, member satisfaction, weekend access, capital
improvement fund and clinical performance. Network expansion.
1998 – RIte Care Eligibility guidelines expanded. Application
process simplified. CHCs start a Management Services
Organization.
1999 – New System Implementation, Audited HEDIS results. NCQA
review. Rapid Plan Growth (60% increase)
2000 – Growth continues. RI Foundation buys Massachusetts CHC
share of plan. Organization converts to not-for-profit with
long-term debt to RI Foundation. Mission unchanged is
strengthened.
Three major challenges the organization faces during 2003:
1. State Budget
2. Market share in mature market.
3. New products to sustain revenue growth.
4. Operational systems. |
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| Last Updated: April 2003 |
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