1. Commonwealth Care MCO Perspective 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*: 139,000 • Commonwealth Care*: 33,000 • Commercial/CommChoice: 30,000 • 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. The 120-Day Launch Massachusetts Health Care Reform Commonwealth Care Health Insurance Program (CCHIP)

5. 120 Days in 2006 JUNE OCT. Jan. 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 ResearchCommissioned 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