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NHP/Brightwood Program Evaluation, Center for Health Care Strategies

Background

In May, 2001 the Neighborhood Health Plan (NHP) and Brightwood Community Health Center in Springfield, MA began an innovative program to change the way health care services are delivered to Brightwood’s MassHealth enrollees. The new program is designed to address the needs of approximately 400 RC V (long term unemployed) and 800 RC II (SSI disabled) enrollees, but it is also expected to identify and serve an unknown number of RC I (TANF) enrollees who have chronic health care needs.

NHP will make a major investment in on-site primary care, care coordination, and behavioral health resources at Brightwood that goes beyond the current primary care or behavioral health capitation payment. The additional primary care and behavioral health staff will target their services to the Medicaid NHP enrollees with chronic and complex health and psychosocial conditions. Risk assessments will be conducted of all NHP enrollees, and individuals will be triaged to the appropriate care managers.

Demonstration and Evaluation Hypothesis

The underlying hypothesis of this demonstration is that a managed care organization has the ability to use capitation payment to finance the health center’s transformation of a fragmented care delivery system to provide cost effective care that meets the needs of members with complex disabilities and illness. Components of this evaluation include:

1. Structural evaluation
   1. Staffing patterns and provider roles
   2. Service integration
   3. Financing
   4. Utilization Management
   5. Outreach
2. Process evaluation
1. Model implementation
2. Culture and community
3. Risk assessment process
4. Outreach and enrollment processt
5. Obstacles and challenges, perceived successes
6. Environmental issues – for NHP, for Brightwood, for DMA
3. Outcomes evaluation
1. Provider experience
2. Enrollee experience
3. Pre- and post- enrollment cost and utilization