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” Today’s Topics

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.

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 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. Maine Community Health Options 5 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

“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 Shared Wellness & Decision Health Promotion Making Complex Health Needs Care Intensive Gaps in Coordination Case Care Management Disease Complex Case Transitions Management Management in Care Self Care

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 Practices Practices Wellness Wellness NCQA: NCQA: PCMH PCMH’ ’s s Members Community Community Disease Disease Facilities Facilities NCQA: NCQA: Care Teams Care Teams Management Management Health Health Plans Plans Complex Complex Maine Maine NCQA: NCQA: Case Case Community ACO’ ACO ’s s Community Management Management Health Options Health Options

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 Maine Community Health Options 13 MCHO Relationship Pathway Physician contracting occurring at multiple levels . Maine Community Health Options 14

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

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 www.maineoptions.org Maine Community Health Options 18

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