Slides by Scott Taggersell, Director of Business Development at
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Transcript Slides by Scott Taggersell, Director of Business Development at
“To be a leader in transforming the health of Maine
people and positively affecting the Maine economy”
Located in Maine; Centered Around You
Accessible
Member
Directed
Local
Supporting the Maine Economy
Partner with
Maine People
Your Voice is
Our Voice
Transparent
No Shareholders
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COOP
You
MaineBased
Understanding
the Needs of
Maine People
Focused on Maine
Provider Network
NonProfit
Statewide
Care Management
Account Management
Broad Network PPO (Preferred
Provider Organization)
All Maine Hospitals
Border Facilities & Providers
National Network (First Health)
PCPs, NPs& Specialists
MH & SA Providers
Hospitals, Clinics, Pharmacies & Others
No Referrals Required
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Driving forces:
Competitive Pricing & Comprehensive Benefits
Lower Base Rate Than Competition
More Robust Benefits for Small Groups
More Value for Your Premium Dollar
Pricing & Benefit Comparisons Encouraged
Response from Competition: Early Renewals
Missed Premium Savings
Change of Contract Year
Migration to QHP for Most Employers
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Small Group Plans on & off SHOP
Our Approach to Benefit Design Sets Us Apart
Integrated Behavioral and Medical Health
PT/ST/OT at Primary Care Level Cost Sharing
First 3 Mental Health Visits at No Cost
VBID / CISP
Tobacco Cessation
Encourage Member Engagement
Shared Decision Making
Choosing Wisely
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More to Your Bottom Line
Lower Out of Pocket Costs
+
Healthier Employees
+
Less Absenteeism
+
Enhanced Productivity
=
More to Your Bottom Line
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Wellness Adds Value
24/7 Access to
Health Coaches
Registered Nurses,
Dieticians, Respiratory
Therapists
May call you to talk about
your condition
Provide information
Help you make important
medical decisions
Informed
Decisions
Healthy Options Online
Health and Wellness Portal
Get facts on over 6,000 health
topics
Use decision support tools and
videos
Complete your wellbeing
assessment
Join challenges to earn points
and get rewards. Create
personal goals and track
progress
Tobacco Cessation Treatment
Maine Community Health Options Will Cover:
Nicotine Replacement Products Prescribed by a Plan Provider
Products Approved by the FDA for Tobacco Cessation
Tobacco Cessation Education and Counseling
Covered at No Out of Pocket Cost:
Generic Nicotine Replacement Therapy (NRT)*: Gum, Lozenge, Patch
Chantix (up to a 90 Day Supply)
*When prescribed by a Plan Provider
MCHO does not use the “Tobacco Rating Band”
to charge higher Premiums for smokers
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Chronic Illness Support Program
MCHO offers additional help to Members with certain chronic
medical conditions that can be managed for better health.
Asthma
COPD /
Emphysema
Diabetes
Hypertension
Saves Members money by lowering or eliminating Out of Pocket
Costs for Routine Care of a chronic illness.
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Supporting Management of Chronic Conditions
Lower out-of-pocket costs for meds and services
Diabetes
Asthma & COPD
Medications
$0 costing sharing for
Specific medications used to
treat diabetes, hypertension
and hyperlipidemiaGenerics, 50% cost-sharing
for preferred brand
Medications
$0 costing sharing for Specific
medications used to treat asthma
& COPD-Generics, 50% costsharing for preferred brand
Services - $0 cost sharing
Services -
$0 cost sharing when
done by Plan Provider
when done by Plan Provider
Offices Visits to PCP for routine
management asthma, COPD,
emphysema
Pulmonologist consultation;
Pulmonary function test (1/yr.),
Home oxygen therapy assessment
Lab services linked to
asthma/COPD primary diagnosis
code
Offices Visits to PCP for
routine management
Endocrinology consultation
Podiatry Consultation
Nutritional Counseling,
diabetes education,
modification counseling
Diabetic Eye Exam (1/yr.)
1 Glucometer/yr., up to 150
test strips every 90 days
Inhaler adjuncts; Peak flow meter
(1/yr.); Asthma education
Pulmonary rehab., ongoing
exercise program for COPD
Lab services linked to
diabetes primary
diagnosis code.
Home assessment (asthma
only) up to $75/yr.
Hypertension
Medications
$0 costing sharing for
Specific medications used to
treat hypertension and
hyperlipidemia-Generics,
50% cost-sharing for
preferred brand
Services -
$0 cost sharing
when done by Plan Provider
Offices Visits to PCP for
routine management
Cardiology or nephrology
consultation and
management of hypertension
Lab services linked to
hypertension primary
diagnosis code.
Impact of CISP as Seen Through SBC
(Silver Plan example)
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Getting a Quote
Qualified Brokers are Our Primary Channel
By Working with an MCHO Benefits Consultant
7 Simple Steps
Online Proposal, Application and Enrollment
Manage Coverage Online Through the Employer Portal
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Step 1): Basic Information
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Step 2): Employee Census
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Step 3): Benefit Choices
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Step 4): Contribution Method
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Step 5): Employer Contribution Amounts
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Step 6): Compare Plans
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Step 7): Review
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Simple Online Enrollment
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Automated Process Keeps You in the Know
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Ongoing Administration Made Easy
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Summary of Attributes
Local, Accessible
Non-Profit
Comprehensive State-Wide Network
CO-OP; Your Voice is Our Voice
Value Based Insurance Design
Delivering More Value to Employers
Competitive Rates and Comprehensive Benefits
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MCHO Today: Growth
Over 39,400 Members
Over 150 Groups
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MCHO Today: Service
Service Delivery Lessons Learned
Member Services
ID Card
Website Enhancements
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MCHO Today: Business Development
Extensive Broker Network
Dedicated Business Development Team
North:
Robert Guerette, Benefits Consultant
Patrick Hamlin, Account Manager
South:
Sharon Ware, Benefits Consultant
Mari Whittaker, Account Manager
Inside Benefit Sales Consultants:
Matthew Ellis
Kristy Pendexter
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Thank you for your time and interest in
Maine Community Health Options.
Toll Free: 1-855-624-6463
www.maineoptions.org
Business Development
207-402-3353
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