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Network Health VP of Network Management to share insights and best practices

Posted by Christina Jedra  January 24, 2013 10:00 AM

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The following was submitted by Network Health: 

Network Health, a nonprofit Massachusetts health plan that provides access to high-quality, comprehensive health care coverage for more than 215,000 Massachusetts residents with low and moderate incomes, announced today that Paul Burke, the health plan’s vice president of network management, will be speaking at the Provider Contracting and Network Development Meeting hosted by the Association for Community Affiliated Plans (ACAP) in San Jose, California on January 25, 2013. 

ACAP is a national trade association representing 58 health plans in 25 states and the District of Columbia. Their mission is to represent and strengthen these plans as they work in their communities to improve the health and well-being of vulnerable populations, echoing Network Health’s mission to improve the health and wellness of the diverse communities they serve.

Burke will be presenting on behalf of Network Health, an ACAP member, on the health plan’s strategic network development during times of expansion and reform. He will also discuss alternative payment models and the evolution of care delivery. Under the provisions of the Affordable Care Act, health plans could experience a period of rapid growth influenced by many factors, including the potential for Medicaid expansion, the inclusion of integrated managed care enrollment for individuals dually eligible for Medicare and Medicaid, and entrance into the commercial market through state or federally-facilitated exchanges.  

“Challenges will naturally arise from regulatory shifts, forcing health plans to focus on expanding primary care capacity, ensuring network adequacy, and aligning members with appropriate providers,” expressed Paul Burke, Network Health vice president of network management. “In order to respond to these issues successfully, health plans must be proactive and ready their networks in advance, ensuring adequate coverage comprised of high-quality providers with the expertise required to serve the unique needs of their membership populations.”

Under the Massachusetts health reform of 2006, Network Health successfully navigated health care reforms similar to those being implemented under ACA. Since the implementation of Massachusetts health care reform, Network Health has increased membership while achieving a cost reduction by implementing innovative network strategies.

Burke has nearly 30 years’ experience in health care contracting and network management. At Network Health his areas of responsibility include leading the network management team and the development and management of the health plan’s provider network, which includes hospitals, ancillary service providers, physicians, and behavioral health providers. Prior to joining Network Health, Paul served as director of network management and contracting at Boston Medical Center HealthNet Plan. He is currently a member and formerly the chair of the board of directors at HealthCare Administrative Solutions, a nonprofit entity that collaborates on administrative simplifications and evaluates health plan authorization rules.

                                            
About Network Health

Since 1997, Network Health has provided access to high-quality health care for Massachusetts residents with low and moderate incomes. Network Health is a nonprofit, comprehensive health plan serving members through Network Health Together® (MassHealth), Network Health Forward® (Commonwealth Care), Network Health Extend™ (Medical Security Program), and Network Health Choice (an individual and small-group plan).

To improve the health and well-being of its more than 215,000 members and their diverse communities, Network Health offers fully integrated, in-house care management, providing a team of medical, behavioral health, social care, and pharmacy professionals who coordinate member care. Network Health partners with more than 20,000 primary care providers, specialists, hospitals, and community organizations statewide.

Network Health earned the National Committee for Quality Assurance’s (NCQA) “Excellent” Health Plan Accreditation status, NCQA’s highest accreditation rating, for its Network Health Together plan. In 2012, NCQA’s Health Insurance Plan Rankings ranked Network Health as the third highest Medicaid Health Plan in the United States. Since 2010, Network Health has ranked among the top 10 Medicaid health plans nationally, according to NCQA’s Health Insurance Plan Rankings — Medicaid. Network Health is among 10 health plans nationally and the first health plan in New England to earn the NCQA Multicultural Health Care Distinction. Additionally, Network Health is nationally recognized for its innovative programs; it won the Dorland Health Case In Point Platinum Award for “Best Integrated Case Management Team” in 2012 and “Best Overall Case/Care Management Program” in 2010. Network Health is also recognized for its top leadership team among health plans nationwide by HealthLeaders Media.

Network Health became an affiliate of Tufts Health Plan in 2011. Tufts Health Plan is a nonprofit organization nationally recognized for its commitment to providing innovative, high-quality health care coverage to its more than 999,000 members. For 2012 – 2013, its HMO and POS programs are ranked second in the nation according to NCQA’s Health Insurance Plan Rankings — Private, and its Medicare Preferred HMO received a 4.5 star rating from the Center for Medicare and Medicaid Services (CMS) for 2013. With headquarters in Massachusetts, Tufts Health Plan also serves members in Rhode Island. For more information visit www.tuftshealthplan.com

For more information about Network Health, call 888-257-1985 or visit
www.Network-Health.org. Follow Network Health on Facebook and @_NetworkHealth on Twitter.

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