LEWISTON, Maine - Health insurance co-ops were created under the Affordable Care Act with the rationale that they would increase competition and lower prices.
But in January, rating agency A.M. Best expressed concerns about co-ops' financial viability, with 22 out of 23 co-ops around the country reporting net losses through the third quarter of 2014, and one co-op facing liquidation.
The only co-op not considered a concern is Maine Community Health Options.
One of the things that makes Maine Community Health Options, or MCHO, unique is how you find out about it. You'll find outreach reps at industry meetings and trade shows that have nothing to do with insurance - like the Fishermen's Forum, the Agriculture Trade Show, and, on this day, the Landscaper's Trade Show in Augusta.
"Hi! Would you like a bag? Have you heard of our company?" asks Outreach Specialist Malory Shaughnessy. Shaughnessy stands behind a table with a stack of free tote bags and baskets filled with all-natural chap sticks and hand sanitizers to help lure the curious.
Shaughnessy says it's part of MCHO's mission to reach those who've had trouble accessing affordable insurance in the past, grassroots style.
"We find it's important to go to where people are to make sure they get the information," she says, "rather than sitting back and just assuming they're going to come find us and find that information. People are busy. They don't have time."
Current MCHO member Jackie Gallagher stops by. She's a 50-year-old, previously uninsured landscape gardener who bought a plan last year. The reason she chose MCHO? "I reviewed everything online, and that had best options that I was looking for," she says, "and for the price."
Maine Community Health options does boast some of the lowest-priced plans on the online marketplace. It captured 83 percent of Maine enrollees last year. CEO Kevin Lewis says while price is important, members are attracted to MCHO for more than just cost.
"People really do take stock of our brand, and the fact that we are a non-profit co-op, as important decision points for them in making a choice," Lewis says.
Being an insurance co-op means MCHO's members elect the company's board of directors, and the board must include a member majority. "So that's a pretty powerful accountability tool," he says. "It really keeps us focused on the member at the center of our entire model."
Chief Medical Officer Dr. John Yindra says the Chronic Illness Support Program is a prime example of the co-op's local focus. Under the program, members with diabetes, asthma, chronic lung disease, and coronary artery disease pay no cost-sharing for related services.
Yindra says it fulfills MCHO's goal to improve health quality by promoting effective services. "We hope once people know about them and know that the financial barrier is not there, that they'll go ahead and do the right thing," he says.
The co-op also employs a care management team that works with the sickest members to ensure they get the care they need - from collaborating with community health providers to calling members on the phone to check in. Maggie Kelley is director of Medical Services.
"In our world, building rapport and building trust and really removing barriers is the focus," Kelley says. "There's no productivity standard, there's no requirement that they have to move quickly, it's - what's needed to really help the member?"
MHCO Director of Medical Services Maggie Kelley.
Credit Patty Wight / MPBN
The hope is these programs will save the insurance company money in the long run and drive down overall health costs, another MCHO mission.
Along the way, there have hiccups. Last year, it struggled to keep up with call volume during open enrollment. Some members have complained about chronic administrative issues. And within the next 5 to 15 years, Maine Community Health Options needs to pay back $132 million in federal loans.
Dr. Philip Caper, a proponent of a universal health care system, supports the idea of co-ops and their focus on members versus profits. But he questions their longevity. "Well I'm concerned about the co-ops in light of what happened to Maine Blue Cross and Blue Shield, which was a non-profit until roughly the year 2000 when they sold themselves to Anthem," he says.
Caper worries that Maine Community Health Options would succumb to competition from larger, for-profit insurance companies should those companies ever want to get a piece of the co-op's pie.
But executives at Maine Community Health Options say the Affordable Care Act has set up a system that supports insuring the individual market and mitigates some of the risks. And so far, they say, competition has been a good thing, because marketplace plan prices dropped in 2015.
