Mission

Neighborhood Health Plan of Rhode Island, an innovative health plan in partnership with Community Health Centers, secures access to high quality, cost-effective health care for Rhode Island’s at-risk populations.

History

Neighborhood Health Plan of Rhode Island was founded in December 1993 by 13-community health centers in response to the initiation of RIte Care, the Rhode Island Medicaid managed care program. Neighborhood is a 501c3 organization with a 15-member board.

Model / Products offered
Network model. Serve four Medicaid populations in Rhode Island:
1) Families with low to moderate income; 2) Children with special health care needs; 3) All children in the RI foster care system; and 4) Medicaid-only adults.

Enrollment

• More than 90,000 – 20% growth over 5 years; Neighborhood insures:

• 66% of all Medicaid managed care participants in Rhode Island

• 50% of all Medicaid enrollees in Rhode Island

Provider Network

• More than 900 Primary Care Practitioners – 42% of Neighborhood’s members receive their primary care at one of the 21 Community Health Centers in the state

• More than 2700 Specialists

• More than 480 Behavioral Health Providers

• All hospitals in the state

• Nearly every pharmacy in the state

Staff
225

Accreditation
In 2001, Neighborhood became the first community health center based health plan in the country to be rated “Excellent” by the National Committee for Quality Assurance (NCQA). It has retained this “Excellent” designation since that time.

Key Initiatives/Outcomes

• Innovative care management focus on Transitions of Care program to reduce hospital readmits; locked-in networks and pharmacy for frequent emergency room users

• Created new behavioral health services with provider partners, reducing inpatient hospital utilization by 25 percent

• Community Health Center support for electronic health records (EHR) and patient centered medical homes; 100 percent of CHCs in RI engaged in EHR process

• Generic drug utilization rates of between 80-89 percent (varies by population served)

Accomplishments

• NCQA Top Ten Ranking - Neighborhood has been ranked as one of the top Medicaid health plans in America according to rankings by the National Committee for Quality Assurance (NCQA) since the inception of the rankings in 2004. Specific rankings include: Top ten (2004); #3 (2005); #1 (2006); #2 (2007); #4 (2008); #7 (2009); #7 (2010); and #8 (2011).

• Fast Growing Company - Neighborhood’s revenue has grown by more than 112 percent over the past five years and the business was ranked the 6th Fastest Growing Private Company in Rhode Island by Providence Business News in 2010

• Grants - Hablamos Juntos grant (One of two health plans selected by The Robert Wood Johnson Foundation to address racial and ethnic health disparities through medical interpreter reimbursements, standards and training); Center for Health Care Strategies grants (Funding to assess how to incorporate adults with developmental disabilities into Medicaid managed care, to improve access to preventive care services for adolescents, and to help reduce health disparities among pregnant Hispanic women); Centers for Disease Control grant (Beating Asthma - community based asthma program)

• Founding member of the Association of Community Affiliated Plans – group of independent, non profit community based plans dedicated to improving the viability of Medicaid Managed Care (1999)

• Innovation of the Year Award Winner for our Video Conference Medical Interpreting project – Providence Business News (2006)

• Community Service Awards - Reach Out and Read Rhode Island (2011), Back to School Celebration (2011), PerformRx (2010), March of Dimes (2009), The African Alliance of Rhode Island (2008), PARI Independent Living Center (2008), Rhode Island Latino Political Action Committee (2007), Rhode Island Foster Parent Association (2006), Hispanic United Development Organization (2005), Rhode Island Public Health Association (2005), Adoption RI (2004), The Providence Center (2004), Southeast Asian Women’s Leadership Group (2003), Diabetes Foundation of Rhode Island (2003)