“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 - - PDF document
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
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)
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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.
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
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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
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“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
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
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”
MCHO Provider Support Nexus
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MCHO Relationship Pathway
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Physician contracting occurring at multiple levels.
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
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Your Provider Service Team
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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
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MCHO’s Self Service Provider Portal
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www.maineoptions.org
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
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