Medical Center HealthNet Plan is a health maintenance organization

Health maintenance organization

A health maintenance organization is an organization that provides managed care for health insurance contracts in the United States as a liaison with health care providers...

 located in Massachusetts. Founded in 1997 by Boston Medical Center

Boston Medical Center

Boston Medical Center is a non-profit 639 licensed-bed medical center in Boston, Massachusetts. It was created by the formal merger of Boston City Hospital which was the first municipal hospital in the United States and Boston University Medical Center Hospital in July 1996 which was sponsored...

, the Plan manages healthcare coverage for Massachusetts residents participating in MassHealth (Medicaid

Medicaid

Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...

), and Commonwealth Care -- subsidized health insurance programs for low-income individuals. BMC HealthNet Plan has been providing MassHealth members with access to high-quality care since its inception. As part of Massachusetts health care reform

Massachusetts health care reform

The Massachusetts health care insurance reform law, enacted in 2006, mandates that nearly every resident of Massachusetts obtain a state-government-regulated minimum level of healthcare insurance coverage and provides free health care insurance for residents earning less than 150% of the federal...

 that aimed to ensure that all Massachusetts residents have access to affordable health care coverage, the Plan began serving Commonwealth Care members in 2006. The Plan contracts with 15,000 healthcare providers (including 60 hospitals) to deliver care to nearly 250,000 members throughout the state.

Partnering with healthcare providers

BMC HealthNet Plan views its participating providers as partners in a commitment to clinical excellence for low-income individuals and families who are the providers’ patients and the Plan’s members. The Plan’s care-related policies are provider-driven. For example, the Plan requires no pre-authorizations for office visits to participating specialists.

In addition, to better serve its members and provider network, BMC HealthNet Plan has offices in Boston (main office), as well as in New Bedford

New Bedford, Massachusetts

New Bedford is a city in Bristol County, Massachusetts, United States, located south of Boston, southeast of Providence, Rhode Island, and about east of Fall River. As of the 2010 census, the city had a total population of 95,072, making it the sixth-largest city in Massachusetts...

, Springfield

Springfield, Massachusetts

Springfield is the most populous city in Western New England, and the seat of Hampden County, Massachusetts, United States. Springfield sits on the eastern bank of the Connecticut River near its confluence with three rivers; the western Westfield River, the eastern Chicopee River, and the eastern...

 and Pittsfield

Pittsfield, Massachusetts

Pittsfield is the largest city and the county seat of Berkshire County, Massachusetts, United States. It is the principal city of the Pittsfield, Massachusetts Metropolitan Statistical Area which encompasses all of Berkshire County. Its area code is 413. Its ZIP code is 01201...

. The goal of having regional offices is to ensure local support in all regions of Massachusetts where the Plan provides coverage.

Coordinated care coverage

Each BMC HealthNet Plan member selects a personal physician who provides or arranges for the member’s care. All approved physician services, inpatient admissions and outpatient visits are covered. The Plan also offers special care management programs for members who are pregnant or who have asthma

Asthma

Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...

, diabetes, HIV/AIDS or congestive heart failure

Congestive heart failure

Heart failure often called congestive heart failure is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition...

. In addition, members can benefit from the Plan’s behavioral-health care-management services. The Plan focuses on bringing together medical and behavioral health providers to deliver care to the whole person: body and mind. BMC HealthNet Plan seeks to help members and the community-at-large get and stay healthy through a variety of wellness programs, such as those described at the Plan’s Web site, www.bmchp.org. (updated 3 May 2009)