Innovations of the Month: Maine Community Health Options

This post originally appeared in the August 28th edition of NASHCO’s newsletter, News from NASHCO. To read the full newsletter, please click here.


Maine Community Health Options (MCHO) saw tremendous success in its first year of operation, attracting approximately 83% of the marketplace enrollment in Maine. In 2015, MCHO will not only continue to sell policies in its home state; it will also offer policies in neighboring counties in New Hampshire.


Innovation was crucial to MCHO’s initial success. These innovations span customer service, benefit design, care management and payment design, and delivery of care. A few of Maine Community Health Community Health Options’ innovations are outlined in the latest Innovations of the Month.


MCHO picture

MCHO features a user-friendly online storefront that allows consumers to review MCHO plan designs, estimate any applicable subsidies and how they impact plan designs, and easily get a quote based on non-identifiable information. In addition, the MCHO storefront – which is designed by Online Insight, the first member of NASHCO’s Preferred Vendor program – has a direct pathway with the marketplace, further easing the consumer experience and speeding the enrollment process. While not unique among CO-OPs, the robust nature of these decision support tools truly stand out within any Marketplace environment.


As part of its Value Based Insurance Design (VBID) approach, MCHO created the Chronic Illness Support Program which started with four targeted prevalent conditions – diabetes, asthma, COPD, and hypertension – and eliminates financial barriers to managing the routine treatment of those diseases including no copays for office visits, generic drugs, durable medical equipment and labs. MCHO is adding Cardiovascular Disease to its program in 2015.


Knowing the prevalence and stigma of behavioral health problems, MCHO waives the copay on any Member’s first three behavioral health visits. This innovation is designed to reduce, if not eliminate, the inhibition to access timely care well before crisis points emerge. It also reflects the powerful dynamic between mental health and physical health.


As an outgrowth of efforts to foster patient-centered medical homes (PCMH) in Maine, multi-disciplinary Community Care Teams came into existence to provide intensive care management for the highest cost members with Medicaid and/or Medicare. MCHO has taken up this model and contracted with each of the ten CCTs throughout Maine. The CO-OP provides financial support and appropriate data sharing and care coordination for any MCHO members eligible for this innovative model of resource utilization.


In an effort to fuel practice transformation and improved delivery of care, MCHO provides an additional per-member, per-month payment for National Committee for Quality Assurance-certified PCMH practices. The level of additional compensation is tied to the NCQA level of achievement (1-3), and is disbursed based on the attributed membership.


And finally, MCHO worked closely with the state’s largest AIDS Service Organization, the Frannie Peabody Center, to develop a process whereby ADAP (AIDS Drug Assistance Program) could pay the premiums for people the organization serves. That process is now in place and working well, rendering coverage to scores of people who would otherwise have piecemeal access to care based on fragmented funding.