July 3, 2019 (Smithfield, RI) – Dr. Marylou Buyse, MD, MS, has joined Neighborhood Health Plan of Rhode Island (Neighborhood) as chief medical officer and senior vice president. She brings to the state’s largest Medicaid insurer extensive experience in leading innovations in care management focused on providing members in government programs with effective, comprehensive, coordinated care management. She has also led population health and quality outcome focused initiatives for both Medicare and commercial plans.
“Neighborhood is committed to providing our members with high quality, affordable health care and we are fortunate to welcome Marylou to the team to enhance this commitment,” said President and CEO Peter Marino. “With more than 20 years of managed care experience, she brings a depth of industry knowledge in both Medicaid and Medicare that will keep us at the forefront of innovative care for our members.”
Dr. Buyse has served in various clinical leadership roles at health plans, including Highmark, United Healthcare of New England and Scott & White Health Plan of Texas. She also served as the president and CEO of the Massachusetts Association of Health Plans and is a past president of the Massachusetts Medical Society.
“I am thrilled to join Neighborhood, which is consistently ranked amongst the highest health plans nationally by the National Commission for Quality Assurance (NCQA). I was also drawn to the mission-driven culture of Neighborhood which is devoted to working together to improve the healthcare experience for our members,” said Dr. Buyse.
Dr. Buyse has served on various boards, committees, and commissions including the Massachusetts Health Council, Massachusetts Cost and Quality Council, Commission to End Cervical Cancer, the Massachusetts Health Data Consortium, and the Rhode Island chapters of the American Heart Association and March of Dimes. Additionally, she is a graduate of Leadership Rhode Island.
Dr. Buyse holds a Bachelor of Arts from Hunter College, a Master of Science from University of Wisconsin-Madison in preventative health and administrative medicine, and a medical degree from Drexel University. She did her residency and a fellowship at LAC-USC Medical Center in Los Angeles and is board-certified in pediatrics, medical genetics and medical management.
Neighborhood Health Plan of Rhode Island is a not-for-profit health insurance company (HMO). We currently serve about 200,000 members in the state. About 80 percent of our membership is Medicaid eligible through our ACCESS and TRUST plans. Just under 10 percent of our members utilize our INTEGRITY Medicare-Medicaid Plan (MMP). More than 10 percent of our membership represents individuals, families and small businesses who select one of eight Neighborhood commercial plans available through the health exchange, HealthSource RI. Of these members, about 85 percent qualify for federal subsidies to cover a portion of their costs.
In December 1993, Neighborhood was founded in partnership with Rhode Island’s Community Health Centers. We served our first 1,490 members in 1994, and by 2000, we grew to 50,000 members. Starting in November 2013, Neighborhood doubled its membership, revenue, and staff through the introduction of the Affordable Care Act and state leadership’s decision to extend coverage to more Rhode Islanders.
In 2019, we celebrate 25 years of service. Since 2004, National Committee for Quality Assurance (NCQA) has rated Neighborhood one of the top Medicaid health plans in America, and our commercial plans have earned NCQA’s highest accreditation level in 2017. Today, Neighborhood – with 500 employees and $1.4 billion in revenue – serves one out of every five Rhode Islanders.