Fast Facts

Mission

Neighborhood Health Plan of Rhode Island, an innovative health plan in partnership with the 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 the state’s 13 community health centers and the Rhode Island Health Center Association in response to the initiation of RIte Care, the Rhode Island Medicaid managed care program. Neighborhood is a 501c3 organization with a 17-member board.

Model / Products offered

Network model. Serve six 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
  4. Medicaid-only adults with disabilities
  5. Medicaid expansion population, and
  6. Dually eligible (Medicare/Medicaid) beneficiaries

We also serve individuals and small businesses through HealthSource RI (Rhode Island’s health benefits exchange).

Enrollment

More than 200,000 (one of every five Rhode Islanders)

Provider Network

  • More than 1,800 Primary Care Practitioners – Approximately 52% of Neighborhood’s members receive primary care at one of the 29 Community Health Centers in the state
  • More than 5,100 Specialists
  • More than 4,500 Behavioral Health Providers
  • All hospitals in the state
  • Nearly every pharmacy in the state

Board of Directors – Chairperson

Peter J. Bancroft, CPA
President and CEO, WellOne Primary Medical and Dental Care

Chief Executive Officer

Peter M. Marino

Staff

500

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). In 2016 Neighborhood once again earned the “Excellent” status for its Medicaid product for the fifteenth consecutive year. In 2014, Neighborhood achieved the “Accredited” status from NCQA for its commercial marketplace product. 

Key Initiatives/Outcomes

  • Created Health@Home, a home-based care program for highly complex and costly members. Resulted in a 26 percent reduction in Emergency Room visits and 30 percent reduction in medical inpatient days; anticipate saving $2.7 million in first year.
  • Created new behavioral health services with provider partners, reducing inpatient hospital utilization by 25 percent
  • Generic drug utilization rates of between 80-89 percent (varies by population served)
  • 8.6% administration rate (2015)

Accomplishments

  • Fastest Growing Company in the RegionProvidence Business News recognized Neighborhood as the #1 fastest growing large ($75M+) company in 2015. We nearly doubled in membership, staffing and revenue from November 2013 to November 2015.
  • NCQA Top Ten Ranking - Neighborhood was one of two organizations to be ranked a “Top 10 Medicaid Health Plan in America” every year for the eleven years the National Committee for Quality Assurance (NCQA) generated rankings (2004 thru 2014); the other was Kaiser Foundation Health Plan of Hawaii. Neighborhood ranked #1 in 2006. While NCQA no longer ranks companies, Neighborhood still scores among the very top of Plans in NCQA’s new ratings system.
  • Rhode Island ranks No. 1 in children's Medicaid health care quality, according to a 2015 report from the Centers for Medicare and Medicaid Services. Neighborhood serves 66 percent of these children.
  • 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 (1999) -independent, non-profit community-based plans dedicated to Medicaid Managed Care
  • Community Service Awards – United Way’s Charles H. Goss, Jr. Good Neighbor Award (2017),  American Cancer Society, Sandra C. Labaree Volunteer Values Award (2017), AARP’s Maria Matias Health & Wellness Volunteer of the Year Award (2016), The Dominican Independence & Heritage Committee of RI’s Outstanding Dominican Community Leader Award (2016), NCQA Quality Achievement Award (2015), Tiempo Social Magazine (2014), Healthy Moms, Healthy Babies Coalition (2013), Asociación Ecuatoriana De Rhode Island (2013), Latino Public Radio (2012), Living Well Rhode Island (2011), 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), Rhode Island Parent Information Network (2004), Southeast Asian Women’s Leadership Group (2003), Diabetes Foundation of Rhode Island (2003).