Neighborhood Health Plan

Business Situation

Neighborhood Health Plan has grown from 80,000 members to almost 200,000 members in the last 9 years. Since 80% of the membership is funded through the Commonwealth of Massachusetts Medicaid fund, NHP’s challenge has been to support a geometric growth in transaction volume (enrollment, claims and referrals, claims payments) with a limited budget.

Outcome

NHP was able to simultaneously reduce their IT cost to 23% below the industry average and move from the number #27 to the #2 ranked Medicaid Plan according to US News and World Report.  They did this by having an explicit understanding of how their business processes, IT system, and the organization are aligned to deliver on their strategy. Through Business Process Innovation-NHP has dramatically increased automatic processing of eligibility and claims transactions through EDI and web gateways that provider use. Through People-NHP has increased internal collaboration and reduced demands on IT by deploying their corporate intranet on Microsoft Office SharePoint Server. Cross functional project teams are collaborating and automating project status reporting that has resulted in greater transparency of activities and results. They have established accountability for performance by publishing RACI (responsible, accountable, consulted, informed) matrices for each department’s business capabilities. Through Technology-NHP is using business intelligence and capability content management to report performance and more effectively train staff through the use of Accelare’s WhatFirst tool and SharePoint. NHP is also deploying digital dashboards through an extranet to report to their provider network financial and clinical performance.