Tufts Associated Health Maintenance Organization Inc

What it reported doing in 2024

Program service accomplishments - commercial hmo product one of tahmo's largest products is its commercial hmo which provides affordable health coverage to its members. Tahmo strives to provide hmo coverage that is affordable, and provides access to top quality health care services. Tahmo also provides programs that target the improvement of the health of its members, as well as the community at large. Quality: ncqa evaluates health plans on the quality of care patients receive, how satisfied patients are with their care, and health plans' efforts to keep improving. Tufts health plan hmo/pos/epo's ncqa quality rating is consistently within the top 10% of plans throughout the country. Tahmo continues to implement outreach programs with both providers and members with the goal of improving the quality of care provided and received. Updated ratings will be released in september 2025. Tahmo provides specialty care management services for its members with complex medical and behavioral health conditions. Tahmo members receive targeted health reminders to encourage preventive health care.tahmo's care managers assist members who are ill or disabled in navigating the health care system and provide referrals to community resources. Our website, www.tuftshealthplan.com , is available to the community at large, and includes a library of tools and ready-made print and electronic materials. These resources help to encourage healthy behaviors, increase demand for preventive health, and drive engagement in programs that educate and empower healthier lifestyles and reduce health risks. Topics include preventive care benefits, healthy eating and weight control, exercise and fitness, managing stress and heart health, cancer prevention, and tobacco cessation. We also offer a variety of wellness programs at the worksite such as flu shots, cholesterol screenings, stress management, and more. Tahmo's secure online account serves as a central hub for lifestyle management program components, health and wellness content, and tools. The online account offers a personal health assessment and resources designed to encourage individuals to lead healthier lives based on their interests, overall health condition, and other personal attributes. Commercial members of tufts health plan continue to receive the member newsletter. The newsletter is an educational resource on topics pertaining to access to services, preventive care, health education and lifestyle reminders. It also helps members utilize their covered health plan benefits, services and features to the fullest and is aimed at supporting their improved health. Access: tahmo's members have access to hospitals, primary care providers and specialists and allied health professionals, as well as condition management programs, prevention and wellness programs. Affordability: tahmo's goal is to provide access to the highest quality health care services through affordable health coverage to as many Massachusetts and Rhode Island residents as possible. Tahmo has designed health management programs to simultaneously lower medical costs and improve quality and outcomes. By lowering medical costs, tahmo is able to offer competitive premium rates and provide coverage to more people. Tahmo is committed to improving the health of the community as well as that of its members. The organization takes this commitment seriously and has a dedicated community partnership program that provides in-kind and financial support to not-for-profit programs throughout Massachusetts. Support is broad based and reflects diverse sponsorship of organizations that promote improved community health. ----------

Financial Efficiency

• Mission deployment rate: 98.8%; rating input score 99
• Program expense ratio: 92.7%; rating input score 93
• Fundraising efficiency: Limited

Transparency & Controls

• Consistency checks: 93.8%; rating input score 94; 28th percentile among comparable filings
• Pay-setting controls: 0 of 6 controls in place; rating input score 0
• Foreign activity oversight: Limited
• Grant itemization coverage: 10.4%; rating input score 10; 6th percentile among comparable filings
• Major donor itemization: Limited
• Related-party transparency: Yes; rating input score 100
• Public monitoring controls: Limited
• Public policy transparency: Limited
• Public financial transparency: Limited
• Impact reporting controls: Limited
• Public relationship transparency: Limited

Accountability

• Independent voting board: 100%; rating input score 100; 76th percentile among comparable filings
• Governance controls: 9 of 9 controls in place; rating input score 100
• Public governance controls: Limited
• Zakat policy transparency: Limited

Sustainability

• Operating margin: -7.6%; rating input score 9; 9th percentile among comparable filings
• Operating reserve ratio: 0.34; rating input score 11; 11th percentile among comparable filings
• Liabilities to assets ratio: 0.59; rating input score 28; 28th percentile among comparable filings
• Officer compensation ratio: 0%; rating input score 94; 94th percentile among comparable filings

Growth

• Program expense growth: -1.1% per year; rating input score 0; 5th percentile among comparable filings
• Revenue growth: -0.7% per year; rating input score 0; 4th percentile among comparable filings
• Asset growth: 1% per year; rating input score 100; 10th percentile among comparable filings