Todays Topics What is a Consumer Operated and Oriented Plan ( CO-OP - - PDF document

today s topics what is a consumer operated and oriented
SMART_READER_LITE
LIVE PREVIEW

Todays Topics What is a Consumer Operated and Oriented Plan ( CO-OP - - PDF document

To be a leader in transforming the health of Maine people and positively affecting the Maine economy Todays Topics What is a Consumer Operated and Oriented Plan ( CO-OP )? Authorized in the ACA, a CO-OP is a non-profit, consumer-focused


slide-1
SLIDE 1

“To be a leader in transforming the health of Maine people and positively affecting the Maine economy”

Today’s Topics

slide-2
SLIDE 2

What is a Consumer Operated and Oriented Plan (CO-OP)?

Authorized in the ACA, a CO-OP is a non-profit, consumer-focused and directed health insurer, with a focus on the following: Consumer (member) led governance Greater accountability to its members Emphasis on quality and coordinated care Lowering health care costs Affordable access to coverage Enhanced competition within insurance exchanges (Marketplace)

Maine Community Health Options 3

Maine’s CO-OP: Maine Community Health Options

Our Mission and Vision

“To partner with Maine people, businesses and health professionals to provide affordable, high quality benefits that promote health and well-being” To be a leader in transforming the health of Maine people and positively affecting the Maine economy.

slide-3
SLIDE 3

MCHO Purpose

To deliver meaningful health insurance benefits designed to improve consumer health and well-being by: Integrating and coordinating care Paying for what matters by engaging in market reform and payment incentives to improve efficiency and quality Being a trusted partner

Maine Community Health Options 5

MCHO views its establishment of a CO-OP as an opportunity to develop a new model of providing health insurance coverage that entails payment reform, reinvestment into primary care, and lower administrative costs with savings passed directly on to the businesses and subscribers themselves as the controlling entity of the non-profit CO-OP.

Timeline

 September, 2011: MCHO Incorporated  October 2011:

  • MCHO Submitted Application to CMS for CO-OP Financing
  • MPCA received MeHAF funding to assist MCHO development

 March 23, 2012: MCHO awarded $62.1 Million in federal financing  September 2012: MCHO opened office in Bates Mill, Lewiston  January 2013: MCHO received $300,000 from MeHAF for marketing

support

 February 28, 2013: MCHO received its Certificate of Authority from

the Maine Bureau of Insurance.

 April 2013: MCHO opened permanent offices, Bates Mill  May 2013: Benefit design and rates submitted to BoI  July 31, 2013: QHP Rates & Forms Due to CMS  October 1, 2013: Marketplace Open Enrollment Begins  January 1, 2014: Healthcare coverage scheduled to be effective

Maine Community Health Options 6

slide-4
SLIDE 4

“To be a leader in transforming the health of Maine people and positively affecting the Maine economy”

Care Management Considerations

Member Values & Preferences Member Satisfaction Quality Outcomes Cost-Effectiveness

Complex Health Needs

Wellness & Health Promotion

Transitions in Care

Intensive Case Management

Disease Management Care Coordination Self Care

Complex Case Management

Gaps in Care Shared Decision Making

slide-5
SLIDE 5

MCHO Approach…

  • Maine based/Member Centric
  • Advisory Councils (Provider & Community)
  • Quality Improvement Program participation
  • Value Based Insurance Design
  • Emphasis on prevention and primary care
  • Integrated Medical and Behavioral Health
  • Chronic Illness Support Program
  • Asthma, COPD, Diabetes, Hypertension
  • Leverage local care management
  • Support local care coordination efforts
  • Avoid duplication of services
  • Provide wrap around support

Care Coordination

Facilities Facilities

NCQA: NCQA: PCMH PCMH’ ’s s

NCQA: NCQA: Health Health Plans Plans

Complex Complex Case Case Management Management Disease Disease Management Management Community Community Care Teams Care Teams Wellness Wellness

Maine Maine Community Community Health Options Health Options

Practices Practices

NCQA: NCQA: ACO ACO’ ’s s

Members

slide-6
SLIDE 6

Care Management Approach

  • Support Triple Aim
  • Develop Partnerships
  • Leverage Local Care Management
  • Support Integrated Services
  • Embrace Values & Preferences
  • Drive Data
  • Provide Transparency
  • Remain Nimble

Maggie Kelley, NP, Director, Care Management & Quality

“To be a leader in transforming the health of Maine people and positively affecting the Maine economy”

slide-7
SLIDE 7

MCHO Provider Support Nexus

Maine Community Health Options 13

MCHO Relationship Pathway

Maine Community Health Options 14

Physician contracting occurring at multiple levels.

slide-8
SLIDE 8

MCHO Support Using Local Assets

 Local Customer Service

 MCHO’s call center based in Lewiston, ME

 Local Care Management

 MCHO Care Managers based in Lewiston  Support & preference for local care management  Engagement of CCTs

 Local Credentialing Processes

 Committee comprised of Maine practicing clinicians  Synernet & CAQH as supporting partners  In-house credentialing staff to support you

Maine Community Health Options 15

Your Provider Service Team

Maine Community Health Options 16

slide-9
SLIDE 9

Coming Soon

 MCHO’s Provider Manual & Guidelines  Training Events

 Regional sessions  Webinars  One on one in-service

 MCHO’s QHP Certification

 Approval & release of benefits & rates

 Open Enrollment, 10/1/2013  Self Service Provider Portal

 www.maineoptions.org

Maine Community Health Options 17

MCHO’s Self Service Provider Portal

Maine Community Health Options 18

www.maineoptions.org

slide-10
SLIDE 10

Thank you for your time and interest in Maine Community Health Options.

Kevin Lewis, CEO Robert Hillman, COO Maggie Kelley, NP Director of Care Mgmt & Quality Maine Community Health Options 207-402-3330 www.maineoptions.org

Maine Community Health Options 19