HMO Self-Assessment Update Form Years 2 and 3 – Note: This form is to be completed in the two Fiscal Years following the HMO’s completion of its triennial Community Health Needs Assessment I. Community Benefits Process: Has there been any change in the past year to the composition or leadership of the Community Benefits Advisory Committee/committee responsible for oversight of Community Benefits programs? Yes No If so, please list updates: II. Community Engagement: If there have been any updates to the key partners with whom the HMO collaborates, please indicate in the table below. Please feel free to add rows as needed. Organization Name and Title of Key Brief Description of Engagement Contact Please use the spectrum below from the Massachusetts Department of Public Health to assess the level of engagement with the community in implementing its plan to HMO’s address significant documented needs, and the effectiveness of its community engagement process. Category Level of Did Engagement Meet Goal(s) for Engagement Goals? Engagement in HMO’s Upcoming Year(s) Overall engagement in implementing plan to filer’s address significant documented needs
HMO Self-Assessment Update Form – Years 2 and 3 Note: This form is to be completed in the two Fiscal Years following the HMO’s completion of its triennial Community Health Needs Assessment I. Community Benefits Process: Has there been any change in the past year to the composition or leadership of the Community Benefits Advisory Committee/committee responsible for oversight of Community Benefits programs? Yes No If so, please list updates: II. Community Engagement: If there have been any updates to the key partners with whom the HMO collaborates, please indicate in the table below. Please feel free to add rows as needed. Organization Name and Title of Key Contact Brief Description of Engagement Please use the spectrum below from the Massachusetts Department of Public Health to assess the HMO’s level of engagement with the community in implementing its plan to address significant documented needs, and the effectiveness of its community engagement process. Category Level of Engagement Did Engagement Meet HMO’s Goals? Goal(s) for Engagement in Upcoming Year(s) Overall engagement in implementing filer’s plan to address significant documented needs